Knowledge and Feeding Practices as Correlates of Caregiver-reported Childhood Malnutrition: A Cross-sectional Study in Zanzibar

Abstract

Introduction: Malnutrition remains a major cause of morbidity and mortality among children under five in low and middle-income countries. Suboptimal breastfeeding and complementary feeding practices, often driven by limited caregiver knowledge, financial barriers, and inadequate access to nutrition education, significantly contribute to poor nutritional outcomes. Objective: To assess caregivers’ knowledge and feeding practices related to infant and young child nutrition, and to identify opportunities for improving nutritional outcomes among children under five. Methods: A cross-sectional study was conducted among 96 caregivers of children under five who reported Child malnutrition. Data collected included sociodemographic characteristics, breastfeeding and complementary feeding practices, nutrition knowledge, and perceived challenges. Statistical tests were performed to assess associations between feeding practices, caregiver knowledge, and child malnutrition status. Results: A significant association was found between malnutrition type and caregivers’ knowledge of the recommended duration of exclusive breastfeeding (Likelihood Ratio = 15.69, p = 0.016). The type of complementary food provided was also significantly associated with malnutrition status (χ² = 34.46, p < 0.001), as was the relationship between a history of malnutrition diagnosis and the current malnutrition category (χ² = 42.91, p < 0.001). Overall, most caregivers exhibited limited knowledge of recommended feeding practices, with major gaps in understanding the timing and nutritional adequacy of complementary foods. Financial constraints, lack of nutrition education, and common misconceptions were reported as key barriers. Despite these challenges, most caregivers expressed a strong willingness to participate in nutrition training. Conclusions: Caregivers face substantial informational and socioeconomic challenges that heighten the risk of malnutrition in early childhood. Strengthening community-based nutrition education, improving access to counselling services, and addressing financial barriers are essential for improving feeding practices and promoting healthier growth among children under five.