Complementary Feeding Practices and Household Food Insecurity Status of Children Aged 6–23 Months in Shashemene City West Arsi Zone, Oromia, Ethiopia

Introduction Appropriate infant feeding practices are critical to a child's growth, health, and development during the first 1000 days of life. One in every six children worldwide receives a minimum acceptable diet. According to the EDHS 2016, the status of the minimum acceptable diet was 7 percent among children aged 6–23 months in Ethiopia. The study sought to ascertain the relationship between complementary feeding (CF) indicators and household food insecurity in children aged 6–23 months. Methods A systematic sampling method was used to conduct a cross-sectional study of 536 mother-child pairs aged 6–23 months. The 24-hour dietary recall was used to collect data on CF practices using face-to-face interviews with socioeconomic and food security questionnaires. The relationship between complementary feeding indicators and household food insecurity was investigated using logistic regression analysis. The relationship between independent variables and complementary feeding indicators was determined using multivariate logistic regression. Results Overall, a total of 67.9% of children received timely introduction of CF and Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), and Minimum Acceptable Diet were met by 61.7%, 42.5%, and 41.7%, respectively. Result of multivariate logistic regression showed there is significant association between household food security with MMF, MDD, and MAD [AOR: 2.02, 95% CI: (1.25–3.24); AOR: 1.55, 95% CI: (1.02–2.36); and AOR: 1.62, 9595% CI: (1.06–2.47)], respectively, while there was no association with introduction of CF [AOR = 0.87, 95% CI: (0.55–1.39)]. Conclusion This study revealed that the rates of MMF, MDD, and MAD remained low in this study setting. Household socioeconomic status (wealth index, food security status, household income) and child age were found to be among the factors statistically significantly associated with complementary feeding practices indicators.


Introduction
e first 1000 days of a child's life are crucial for promoting health and development as well as preventing stunting. Inadequate quantities and quality of complementary foods, as well as poor feeding practices and increased infection rates during this period, may be risk factors for stunting in children [1]. Appropriate infant feeding practices are critical for a child's growth, health, and development during the first two years of life [2]. CF refers to a gradual dietary transition involving the introduction of solid and semisolid foods to the infant's diet when breast milk alone is no longer sufficient to meet an infant's nutritional needs [3].
WHO recommends that all children be exclusively breastfed for the first six months of their lives and then receive complementary foods that are nutritionally safe and adequate until they are two years old or older [4]. Malnutrition has been linked to poor breastfeeding and complementary feeding practices of mothers, as well as a high rate of infectious diseases, in the first two years of life [5]. Complementary feeding practices that are insufficient in terms of quality, quantity, and frequency of meals have a negative impact on children's health and growth in the first two years of life [6,7]. Globally, one in six children receives a minimum acceptable diet [8]. e study found that less than onefourth of the children aged 6-23 months in developing countries had good consumption quality [8]. WHO shows the effect of feeding practices on the nutritional status of children; about 32% of children under 5 were stunted and 10% were wasted due to poor BF and CF [9].
Household food insecurity is another important cause of malnutrition that has an effect on vulnerable groups in societies, especially the poor women of reproductive age and children under the age of five as they are at high risk [10]. e 2018 Global Nutrition Report revealed the fact that diets of infant and young children are suboptimal everywhere in all wealth groups from 75.6% in the lowest to 56.7% highest quintile; besides this, 74.6% of children of 6-23 months of age do not have sufficient diet diversity for a healthy diet worldwide [11]. Like most developing countries, improper feeding practices remain a challenging problem in Ethiopia. In Ethiopia, only 7% of children aged 6-23 months met the minimum acceptable diet [12]. is is an alarming gap; still all children have the need and right to sufficient food to support life; there is limited evidence that shows an association between CF indicators with household food security status in Shashemene city, Oromia, Ethiopia.
us, this study is designed to assess the association between CF practices and household food security status of children aged 6-23 months in the study setting ( Figure 1).

Operational Definitions.
Timely introduction of complementary feeding: the proportion of children aged 6-23 months who were introduced to solid and semisolid foods at 6 months of age [13,14].
Minimum dietary diversity (MDD) is the proportion of children of 6-23 months of age who receive foods from 4 or more food groups with the food groups consisting of (I) grains, roots, and tubers; (II) legumes and nuts; (III) dairy products; (IV) flesh foods; (V) eggs; (VI) vitamin A-rich fruits and vegetables; and (vii) other fruits and vegetables during the previous day of study [13,14].
Minimum meal frequency (MMF) is the proportion of breastfed and nonbreastfed children of 6-23 months of age, who receive solid, semisolid, or soft foods (but also including milk feeds for nonbreastfed children) the minimum number of times or more during the previous day [13,14]. e minimum is defined as 2 times for breastfed infants of 6-8 months, 3 times for breastfed children of 9-23 months, and 4 times for nonbreastfed children of 6-23 months [13,14].
A minimum acceptable diet (MAD) is the proportion of children of 6-23 months of age who receive both MMF and MDD during the previous day of study [13,14].

Study Settings and Period.
e research was carried out in Shashemene City from February to March 2020. Shashemene is the most densely populated city in the region, with a diverse ethnic population. It is 250 kilometers from Finfinnee, the capital of Oromia, Ethiopia. Shashemene city is located in the subtropical climatic zone: Shashemene's population is estimated to be 272193 people: in 2019, males accounted for 50.4 percent of the population, while females accounted for 49.6 percent. According to the Shashemene health office report, children aged 6-23 months made up 4.8 percent of the population, or 13065 people.

Study Design and Population.
A community-based cross-sectional study was conducted in Shashemene city, Oromia, Ethiopia, from Feb to March in 2020. All mothers who had children aged 6-23 months residing in Shashemene city by 2020 considered as source population whereas mothers of children aged 6-23 months living in selected households during the study period and resided in the study area for more than 6 months were taken as the study population.

Inclusion and Exclusion
Criteria. All mother-child pairs aged 6-23 months living in Shashemene city were taken as source population, whereas mother-child pairs aged 6-23 months living in the selected household during the study period as well as resided in the study area for ≥6 months presented during the study period were included as study population while those resided in the study area for <6 months were excluded from the study subjects.

Independent and Dependent Variables.
e outcome variable was the CF indicators (timely introduction of CF, MMF, MDD, and MAD). e independent variables were maternal, child, and household characteristics. Briefly, the description of the variables was as follows: sociodemographic characteristics: age, sex, family size, monthly income, partner's education level, and household food security were measured with the Household Hunger Scale (HHS), household wealth index, food insecurity, occupation, residence, knowledge, and attitude of mothers, Obstetric history: pregnancy history, ANC, PNC, delivery mode and place of delivery, birth space, and number of parity) were the independent variables.
As per the WHO definitions already given in the introduction, children receiving the recommended feeding were coded 1 and all other children were coded 0. ese are the food groups used in constructing the MDD and MAD, with data on feeding obtained through 24-hour recalls by mothers: grains, roots, and tubers; legumes and nuts; dairy products (milk, yogurt, and cheese); flesh foods (meat, fish, poultry, and liver/organ meats); eggs; vitamin-A-rich fruits and vegetables; and other fruits and vegetables [14]. Household food security was measured with the Household Hunger Scale (HHS) that has 9 items along with 9-frequency (9I 9 F) Household Food Insecurity Access Scale (HFIAS) [15].

Sample Size Determination.
e sample size was determined by a single population proportion formula taking the proportion of appropriate complementary feeding practice 11.4% from the previous study [16]. e following assumptions were used: margin of error � 4%, Zα � 1.96, and design effect � 2.243; a total of 536 samples mothers were obtained with consideration of 10% contingency to nonresponders.
(1) 2.6. Sampling Procedure. e study subjects were chosen using a two-stage sampling technique. A simple random sampling method was used to select four subcities at random from a total of eight subcities. e total population in the four selected subcities, Buchanan, Arada, Alelu, and Awasho, was 36877, 34529, 31734, and 36370 (139510), with 6696 children aged 6-23 months. e calculated sample (536) was divided equally among the four subcities, resulting in 134 mothers with children aged 6-23 months. To obtain individual sample units or subjects at the household level, all target groups of the subcity were obtained from the health post prior to calculating Kth and then determining K. e random start was determined by lottery, and every Kth mother with eligible children was chosen from four subcities using systematic random sampling; thus, a child was chosen in each subcity, and his or her mother was interviewed accordingly. One eligible child with a mother at the time of the survey was chosen from each household; if more than two eligible children were found, the younger was chosen, and the process was repeated until the next Kth in the same direction. If the mother was not present on the day of data collection, she was replaced by the next mother from the same subcity after one visit. It was summarized below ( Figure 2).

Data Collection
Instruments. Data were collected by using face-to-face interviews during a home-to-home visit from mothers who had children aged 6-23 months using a structured questionnaire. e questionnaire comprised background information on individual characteristics: mothers' age, education, employment status, obstetrics, maternal health practice, children's, age, CF feeding practices, BF, and household characteristics: wealth index, income, and food security/insecurity issues.

Data Collection
Methods. Data was collected by using face-to-face interviews during a home-to-home visit from mothers who had children aged 6-23 months using a structured questionnaire. For data collection, first of all, we were collected information about dietary diversity (MDD) meal frequency and MAD of children by using the 24-dietary recall. Socioeconomic and demographic characteristics of children were collected. e four main complementary feeding indicators (timely introduction of CF, MMF, MDD, and MAD), and food security items were included in the questionnaire via 24-hour dietary recalls of food and liquid consumption during the prior day of the survey [13].
Six diploma holder data collectors and two BSc holder supervisors were recruited. For data quality control, the questionnaire was first developed in English and translated to the local language, Afaan Oromo, and then backtranslated to English by two people, who have good command in both languages for consistency. e training was given to data collectors and supervisors for 2 days and the questionnaire was pretested in 5% of mothers, in the study area, which is not included in the actual study to assess the content and approach of the questionnaire and the necessary correction was made. All questionnaires were checked on daily bases  for completeness while data was thoroughly checked and cleaned before analysis.

Data
Processing and Analysis. Data were coded, entered, and analyzed using SPSS version 25. Descriptive statistics such as frequencies, proportions, means, and standard deviation are used to describe data. Bivariate analysis was made to describe the relation of each independent variable with the dependent variable. Finally, independent variables associated during bivariate analysis with P-value ≤0.25 were entered into multivariable logistic regression analysis used to determine the strength of association between independent and dependent variables. OR along with 95%, CI was reported, and the statistical significance was declared at the p-value <0.05. Multivariate logistic regression model was used to control confounders. CF indicators were compared with household food security: Wealth index was computed as a measure of household wealth using principal component analysis (PCA). Fifteen variables related to ownership of selected household assets, size of quantity of durable equipment, materials used for housing construction, and ownership, improved water, and sanitation facilities were considered. Finally, the generated principal component was divided into 5 equal quintiles (lowest, second, middle, fourth, and highest) while household food security was measured with the Household Hunger Scale (HHS) which has 9 items along with 9-frequency (9I 9 F) Household Food Insecurity Access Scale (HFIAS) [15]. e response categories are never (0 times), rarely (1-2 times), or sometimes (3-10 times), and often (more than 10 times). erefore, the HHS was used in this study to define two groups: households reporting (a) little to no hunger in the past month because of insufficient food or because of lack of resources to get food and thereby classified as food secure households and (b) moderate-to severe hunger in the past month because of insufficient food or because of lack of resources to get food, and thereby classified as food-insecure households.

Sociodemographic Characteristics of Study Subjects.
In this study from 536 sampled mothers, 520 mother-child pairs participated in the study giving the response rate of 97.01%. e mean age of mothers was 26.83 SD (±4.41) years. More than half of the study subjects were between the ages of 25 and 34 years. e most common source of drinking water in study areas is an improved drinking water which piped into the dwelling, a public tap or standpipe 505 (97.1%), the rest 15 (2.9%) from bottled water. Regarding educational status, about 22% of mothers had basic education only whereas 14.8% percent of the households has no work. Of the total study subjects, 481 (92.5%) were married, live at a different place and not married each 14 (2.7%), divorced 10 (1.9%), 1 (.2%) widowed, and 325 (62.5%) Muslim by religion. With regard to ethnic distribution, nearly 2/3, 333 (64%) of the respondents, belong to Oromo ethnic groups. Regarding household food security, out of 520 respondents 407 (78.3%) of children's mothers were under the household who met food security whereas 113 (21.7%) were reported to have had insecure food in the two-week period before the survey (Table 1).
e most common sources of information for the mothers of children aged 6-23 months were health care workers (HCWS) followed by radio ( Figure 3). Most study   Concerning delivery attendants, and place of delivery, 426 (81.9%) of mothers were delivered at health facility compared to 94 (18.1%) of home delivery, while 460 (88.5%), 35 (6.7%), and 25 (4.8%) of mothers delivered their children with the assistance of HCWs, TBAs, and others, respectively. Relating to postnatal care, a large proportion of maternal and neonatal deaths occur during the 48 hours after delivery, and these first two days following delivery are critical for monitoring complications. e level of postnatal care coverage is extremely low in this study setting. e great majority of women 231 (44.4%) with a live birth in the preceding survey did not receive a postnatal checkup while among women who received a postnatal checkup, 128 (24.6%) within 0-2 days, 127 (24.4%) within 3-6 days of delivery, and 34 (6.5%) received a postnatal checkup within 7 days and above.
Almost all mothers 519 (99.8%) BF their children after delivery indicate that very young children are mostly fed breast milk, as recommended by WHO. Most of them 482 (92.7%) feed breast milk based on child demand. e median duration and the mean duration of any BF in Ethiopia are 25 months. In this study, result indicates mothers' BF status; the median duration of BF was 14 months (i.e., 243/520 (46.7%) lower than the EDHS, 2011) ( Figure 4).

Food and Fluid
Provided for the Children. Milk (417 (80.2 percent) was the most commonly provided food or fluid for children, followed by potatoes (324 (62.3 percent), porridge/ gruel 235 (45.2 percent), and bread, vegetables, and fruits 181 (34.8 percent). e most preferred food for the children was homemade, accounting for 398 (76.5 percent), while commercially available food was preferred by the remaining 122 (23.5 percent). In terms of CF practices and frequency during illness, 187 (36%) mothers decreased food quantity and frequency, 147 (28.3%) withheld food quantity and frequency, 123 (23.7%) mothers maintained the same quantity and frequency, and only 63 (12%) mothers increased food quantity and frequency. Due to cultural practices, approximately 124 (23.8%) of mothers did not provide cabbage and meat to their children between the ages of 6 and 23 months. Concerning food preparation, out of 520 mothers, 452 (86.9%) prepare separately for a child while 68 (13.1%) prepared with adult food.
Grains, roots, and tubers were the most commonly taken food items followed by dairy products, among all age categories children in the previous 24 hr preceding the survey. Legumes and nuts, eggs, and vitamin A-rich fruit and vegetables were consumed higher among children aged 18-23 months compared to the other groups in 24 hr preceding survey. Eggs were     Figure 5 indicates household food security status among mothers of 6-23-month children in Shashemene city. e lowest proportion who met MAD was (31.2%) in the age group of 6-9 months. However, overall, less than half (42.5%) and 156 (30%) of children aged between 6 and 23 months met the requirements for MDD and ACFP, respectively. Chi-square illustrations of CF indicators and food insecurity are shown in Table 4. 93 (89.2%) mothers fed their child one or two times among breastfed child 6-8 months' age whereas 313 (73.3%) for breastfed child 9-23 months of age fed three or more times. Tables 5 and 6 showed bivariate and multivariate associations of household food security with complementary feeding indicators, with Table 5 illustrating factors associated with CF among mothers with children aged 6-23 months. To account for potential confounders, multivariable logistic regression was used. Age, education, occupation, household income, child age, sex, wealth index, food security status, and household monthly food expenditure were the variables.

Bivariate and Multivariable Analyses.
In this study, there was no association between maternal occupation, maternal education, age 25-29 years, child sex, and CF indicators. Of the total entered variables, the finding revealed socioeconomic status (wealth index, household food security, household income, and child age) are factors statistically significantly associated with the CF indicator, while the rest of the variables were not associated after controlling for potential confounders though associated in bivariate analyses. Table 5 revealed that there is no association between food security (secure vs. total insecurity) and the introduction of complementary feeding practices at six months (P � 0.45), but there are associations between food security and MMF (0.002), MDD (P � 0.03), and MAD (P � 0.02). ere is a relationship between food security and insecurity and their sub groups (food insecure without hunger (P � 0.23), food insecure with moderate hunger (P � 0.46), and food insecure with severe hunger (P � 0.08)) among MMF CF indicators. Aside from that, the table revealed no link between household food insecurity without hunger and MAD (P � 0.21) or the timely introduction of CF (P � 0.67).
However, there is an association between household food insecurity without hunger with MDD (P � 0.006), timely introduction of CF (p ≤ 0.001) with moderate hunger, and food insecure with severe hunger (P � 0.02). However, there was an association between household food security with moderate hunger and MDD (P � 0.003) and MAD (P � 0.01) as well as food insecure with severe hunger and MDD (P � 0.001), MAD (P � 0.002), and ACFP (p ≤ 0.001). Household socioeconomic status (wealth index) was found to be statistically significantly associated with complementary feeding practices. ose mothers who are in highest percentile were about 7, 3.7, and 3.8 times more likely to practice MMF, MDD, and MAD compared to the others counterparts (those who were in lowest percentile

Discussion
A study was conducted on the association of CF practices and household food security status among mother-child pairs of 6-23 months, which had a response rate of 97.01%. Overall, the result revealed that the magnitude of ACFP was 30%. is is higher than that of the studies done on Damot Sore 11%, Arsi Nagele, 9.5%, and Ghana's 14.3% [16][17][18], but lower than that of Sri Lankans 68%, Bangladeshi 40%, and Nepali 32% [19,20]. is is possibly due to differences in the study setting, socioeconomic status, or indicators used to measure appropriate complementary feeding or sociocultural variances among different populations at different times.
In a recent study, the lowest proportion of children who had been fed with ACFP was in the age group of 6-11 months compared with the counter group. is implies the need to give due attention at a younger age. In this study, the proportion of children who had been introduced to solid, semisolid, or soft foods among those aged 6-23 months was 67.9%, while that of 6-8 months was 86/93, or 92.5%.
is disparity might be due to the sociocultural, educational, and working conditions of caregivers.
With regard to minimum dietary diversity (MDD), the current study also revealed that the proportion of children who met MDD was 42.5%; this reflects the fact that only these mothers fed their young children with four or more food groups from seven food sets (i.e., grains, roots, and  tubers; legumes and nuts; dairy products; flesh foods; vitamin A-rich food; eggs; and other fruits and vegetables) which is almost similar with that of Bangladesh 42%, but higher than the figures stated from studies done in Arsi Nagle 18.8%, Damot sore 16%, India 15%, and Nepal 34%; however, it is lower than that of Sir Lanka 71% [16,17,19,20,26]. While in Eastern and South Africa it was one in ten infant and young children [27]. e high variation from Damot Sore and Arsi Nagele could be due to the fact that the current study was done in the city where there was better information and maternal health care access, which led to a difference in awareness of the mothers and educational status variations, whereas the previous studies were done in rural areas where mothers were less advantageous compared to their urban counterparts. e low consumption of protein-rich foods can be due to a number of factors, including lack of nutritional awareness and a shortage of access due to economic constraints [28]. e percent study revealed the varieties of foods given to younger children are lower and MDD only tends to increase with growing age (Table 3); that is, the lowest proportion who met MDD was found in the age group of 6-11 months. Similar patterns have also been observed in Ethiopia and other developing countries [17,[29][30][31].
is might be because mothers may assume that younger infants do not need diversified food or that their guts may not be able to digest animal-source foods. Besides this, the most commonly restricted foods are meat and cabbage, which is why mothers believe that children cannot swallow them. Moreover, flesh food is the least consumed food across all ages, while eggs are the least consumed in the age group 6-11 months. Subsequently, CF might be initiated with monotonous staples.
is is in line with a study from northern Ethiopia, which found that flesh foods and eggs were introduced in children's diets in the middle of the  [31]. e study observed that household economic status as measured by wealth index and food security level was a significant predictor of MDD. Obviously, the lower economic status restricts the availability and variety of food in the household. e minimum acceptable diet incorporates MMF and MDD, which was 41.7%. is is comparable with findings from Bangladesh of 40% and Ghana of 46% where MAD is adopted [18][19][20]. But this is higher than that of Ethiopia's national level of 7%, and Abiy Adi, north Ethiopia's 11.9%, India's 9%, and Nepal's 32%. But it was lower than the finding from Sri Lanka at 68% [12,19,20,31]. e percent study revealed better conditions in practicing CF indicators than studies done in Damot sore, Arsi Nagele, Abiy Addi ciy, north Ethiopia, and India [16,17,31]. Surely, this is the result of health services provided like health education to people in the community. However, 64.5% of infants of 6-8 months of age received the introduction of CF at 6 months of age in 2017, while global rates of MMF, MDD, and MAD were low, at 50.3%, 28.2, and 15.9%, respectively [32]. e lower level of the result could be attributed to socioeconomic, cultural, and policy differences between the study areas as well as time. us, the low prevalence of this indicator suggests that the majority of children were either not fed as frequently as the recommended 2-4 times daily or were not offered food from four or more of the recommended food groups in their diet. is may have resulted in inappropriate CF practices which led to malnutrition. High MAD in this study was observed as compared to the national figure of 7% as of EDHS 2016. is might be because EDHs were a nationally representative survey with a wide range of child feeding styles in different parts of the regions of Ethiopia, with a diversified sociocultural context. Besides this, the DHS covers both rural and urban areas, which reduces the figure.
e higher figure observed in our study may be due to the current expansion of HEWs in the study area that focused on ANC, PNC, and child care education, which in turn increases maternal exposure to healthcare workers, thus increasing their practices. Moreover, this is a pocket study that is localized into Ciy where there is better access and availability to information, education, healthcare services, and other social services across time variation. Overall, the proportion of children who met ACFP was 30%. is was higher than that of the studies done on Damot sore, 11.4%, Arsi Nagele, 9.5%, and Abiy Addi Ciy, north Ethiopia, where ACFP was 10.5% [16,17,31]. is could be due to differences in the study setting; for example, the previous study was conducted in rural areas of the country where access to maternal health care services and media is limited.

Factors Associated with Complementary Feeding
Indicators.
e current study revealed that household socioeconomic status (wealth index and food security status, household income) and child age are factors significantly associated with ACFP while the rest of the variables were not associated or lost association after controlling for potential confounders though associated in bivariate analyses. One more important determinant factor associated with CF indicators was household economic status as measured by wealth index and food security level. e household wealth index was found to be statistically significantly associated with CF practices. ose mothers who are in the highest percentile were about 6 times, 3.7 times, and 3.8 times, more likely to practice MMF, MDD, and MAD than those who were in the lowest percentile [(AOR � 6.54, 95% CI: (1.84-23.3) * * , (AOR � 3.7, 95% CI: (1.03-13.36) * * , and (AOR � 3.8, 95% CI: (1.05-13.73)] * * , respectively, but no association with the introduction of CF (0.37, 95% CI: (0.10-1.25), P � 0.11). So, this illustrates that economically higher people are more likely to practice CF indicators than their counterparts. In fact, a higher household wealth index is positively associated with higher dietary diversity. Families in the high percentile are more likely to be able to afford and offer a variety of foods to their children more frequently. e positive association between a household with the highest wealth percentile and an increased diet diversity has been consistently reported in previous studies done in Sri Lanka, Pakistan, India, Bangladesh, and Nepal [19,20], which was consistent with our findings. e 2018 Global Nutrition Report also revealed that the diets of infants and young children are suboptimal everywhere in all wealth groups, from 75.6% in the lowest to 56.7% in the highest quintile [11]. e fact that household wealth is a predictor of MDD underlines the important role of household assets in determining optimal CF practices [19,20], which is in line with our findings.
is study contradicted the findings of Damot Sore and Arsi Nagele, as well as Ethiopia, Nepal, and Sri Lanka, in which maternal education was found to be a predictor of ACFP [16,17,19,20,31]. e possible explanations can be the difference in societal norms and cultures, with a geographic difference regarding female education.
Child age is also found to be a predictor variable as older children (18-23 months) are about five times more likely to feed CF indicators compared with younger children (6-11 months). Similarly, studies conducted in five Asian countries and Tanzania, Arsi Nagele, and the northern part of Ethiopia reported child age as a predictor variable [17,19,20,27,32].
is might give an opportunity for the health planners to give due attention to younger children's feeding.
Global nutrition report indicated 74.6% of children 6-23 months of age do not have sufficient diet diversity for a healthy diet worldwide; hence, inappropriate CF after 6 months of age is one major cause of malnutrition; in turn, malnutrition is the leading cause of the global burden of the disease, so attention should be given to young child nutrition education intervention to meet SDG Agenda refers to ending "all forms of malnutrition" [11]. e most important issue regarding feeding during illness was that only 63 (12.3%) of the mothers increased food quantity and frequency. Despite cultural and social food restrictions, commonly on cabbage and meat, which need due attention. Interestingly, there are encouraging practices detected in this study: almost all mothers (519) breastfeed their children after delivery, 496/520 (95.5%) initiate breast feeding earlier, and most of them (482) breast milk based on child demand, whereas 489 (94%) feed EBF versus 58% national Figure of 2016 EDHS. It is recommended that a child continues to breastfeed until the age of two. However, in Ethiopia, the percentage of children who are currently breastfeeding decreases from 91% among children aged 12-17 months to 76% among children aged 18-23 months as of EDHS 2016. at is a bit comparable to this finding.
Homemade food was the most commonly preferred food for the children among 398 (76.5%), while the remaining 122 (23.3%) did not. e most common reasons for early initiation of CF were mothers' negative attitude towards the quantity of breast milk, not staying with the child, and lack of knowledge about breast milk. Nearly 488 (86.2%) mothers used bottle feeding, whereas during illness, only 63 (12%) mothers increased food quantity and frequency, while the rest 88% did not. Despite cultural and social food restrictions on cabbage and meat, which account for 124 (23%), 452 (86.9%) prepared food separately, while 68 (13.1%) were prepared with adult food.
Overall, a low level of ACFP, MDD, and MAD was observed in this study, particularly among children of 11 months of age. erefore, it needs mitigation to improve CF.

Limitations
e limitation of our study was it does not demonstrate a cause-and-effect relationship and it may not provide a complete picture of the areas or zones. Hence, our study was conducted among the residents of a single city, which was not representative of the region. us, generalizing the result may distort the results to other setting, so caution is needed. Furthermore, the figure could have been overestimated or underestimated due to recall and social desirability biases introduced by the time of initiation, diversity, and frequency of food. e 24-hour dietary diversity recall may only show the most recent feeding and necessitates multiple measurements.

Conclusion and Recommendation
As a result, the overall CF indicators were low, negatively impacting the health of infants and young children. is demonstrates the significance of taking immediate action to promote CF indicators. Despite the timely introduction of CF, the proportion of mothers whose children met MMF, MDD, and MAD criteria remained a public health challenge in the study area. Child age and household socioeconomic status (food security, wealth index, and income) were among the factors found to be significantly associated with CF indicators.
6.1. Recommendation. It was stated in previous studies that two-thirds of child's death was attributed to inappropriate CF practices, in this study CF indicators remaining low. So, to scale up successful interventions to levels that would make an impact, Health Bureau, NGOs, and other development sectors should give special attention to: (i) Educational/counseling intervention on nutrition for mothers and/or caregivers is essential for improving infant and young child feeding practices, particularly for mothers with younger children about, time, variety, quantity, and frequency of food (ii) Promoting socioeconomic status of the community, particularly for poor mothers with households with the lowest wealth index/food insecure via multiple discipline/intersect oral collaboration engagement to improve ACFP (iii) To come up with the real figure, large-scale longitudinal study will be proposed for the researcher