Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Mary Slessor Limbe

Second Supervisor/Advisor

Caroline Kathomi

Third Supervisor/Advisor

Anthony Ngugi


Paediatrics and Child Health (East Africa)


Background: More than a third of all deaths in children under five years of age worldwide, are linked to maternal and child under-nutrition. Appropriate complementary feeding is one of the interventions with the greatest potential for reduction of nutrition-related diseases and mortalities, yet uptake of the recommended World Health Organisation (WHO) infant and young child feeding practices in Kenya remains low. Despite provision of nutrition education at Aga Khan University Hospital- Nairobi (AKUH-N), both growth faltering and over-weight trends have been observed, pointing to both under- and over-nutrition.

Objectives: This study investigated caregivers' knowledge , attitude and practice (KAP) of complementary feeding of infants and young children on follow up at AKUH-N well baby clinic based on WHO guidelines. In addition, it sought to evaluate the factors influencing compliance with these guidelines.

Methodology: This was a mixed methods descriptive, cross-sectional study. A total of 290 caregivers of infants and young children aged between nine and twenty-four months were recruited for the quantitative part of the study. Twenty-one caregivers were purposively sampled for the qualitative arm of the study.

Results: Caregivers had an average to good knowledge score, with majority(88.3%) of them reporting the paediatrician as an information source on matters child nutrition. Less than half (43.1%) of caregivers were fully compliant with the WHO guidelines for complementary feeding. Timely introduction, continued breastfeeding, minimum meal frequency and minimum meal diversity were estimated at 76.9%, 74.1%,95.2% and 91.7% respectively. Underweight and stunting rates were at 6.9% and 1.7%, respectively, while that of overweight was 8.6%. Caregivers whose education was below college level were 80% less likely to comply with WHO complementary vi feeding guidelines [OR 0.2 (95% CI 0.05- 0.8) p=0.04].Other factors that affected complementary feeding practice included access to information, support from healthcare workers and fear of allergic reactions.

Conclusion: Caregivers had a good grasp of broad concepts, as evidenced by good knowledge scores, but lacked clarity in specific and practical aspects. This could have led to the incongruence seen between knowledge and practice. Specific knowledge gaps identified were in the areas of responsive feeding, continued breastfeeding, use of feeding bottles and adequacy of feeds. More attention needs to be paid to providing practical guidelines for the complementary feeding period in our setting.

Included in

Pediatrics Commons