Strengthening Infant and Young Child Feeding Practices Through WHO-Based Nutritional Counseling: Evidence from a Quasi-Experimental Study Among Mothers of Children Aged 6–23 Months
Keywords:
Nutrition counseling, Maternal compliance, Complementary feeding, WHO guidelines, Infant and child feedingAbstract
Appropriate complementary feeding practices during the first two years of life are essential for supporting optimal growth and preventing childhood malnutrition. Maternal compliance with recommended complementary feeding practices remains a challenge, highlighting the need for effective interventions that improve maternal feeding behaviors. This study aimed to determine the effect of nutritional counseling on mothers' compliance with complementary feeding practices in accordance with World Health Organization (WHO) guidelines for children aged 6–23 months. A quantitative quasi-experimental study with a one-group pretest–posttest design was conducted among 30 mothers selected through purposive sampling. Maternal compliance with complementary feeding practices was assessed before and after nutritional counseling using a structured instrument based on WHO complementary feeding indicators, including feeding frequency, food diversity, food texture, and food hygiene practices. Data were analyzed using the Wilcoxon Signed Rank Test with a significance level of α = 0.05. Nutritional counseling significantly improved maternal compliance with complementary feeding practices (p < 0.001). Before the intervention, maternal compliance was categorized as good in 30.0% of respondents, fair in 40.0%, and poor in 30.0%. After counseling, good compliance increased to 70.0%, fair compliance remained at 30.0%, and no respondents remained in the poor compliance category. Nutritional counseling effectively improved mothers’ compliance with WHO-based complementary feeding practices among children aged 6–23 months. Structured counseling interventions should be integrated into maternal and child health programs to strengthen feeding behaviors and support improved child nutrition outcomes.
Downloads
References
Andriani, R., Supriyatno, B., Kekalih, A., & Sjarif, D. R. (2023). Development, validity, and reliability of a questionnaire on mothers’ knowledge in complementary feeding practices (PI-MPASI) in Indonesia. Paediatrica Indonesiana, 63(5), 335–345. https://doi.org/10.14238/pi63.5.2023.335-45
Arimond, M., & Flax, V. L. (2025). Progress in improving low-cost measurement of feeding behaviors and diets. Current Developments in Nutrition, 9, 104503. https://doi.org/10.1016/j.cdnut.2024.104503
Ativor, P. S., & Salu, S. (2025). Optimizing minimum dietary diversity: Examining appropriate complementary feeding practices and influencing factors among children aged 6–23 months in Ghana: A cross-sectional study. BMC Public Health, 25, 559. https://doi.org/10.1186/s12889-025-21681-z
Barbosa, C. B., Magalhães, E. I. S., & Rocha, D. S. (2024). Complementary feeding indicators from the World Health Organization and the Ministry of Health: Agreement analysis and comparison of estimated prevalence in a cohort of children in southwestern Bahia, Brazil, 2018. Epidemiologia e Serviços de Saúde, 33, e2023556. https://doi.org/10.1590/S2237-96222024v33e2023556
Bhanot, A., Sethi, V., Murira, Z., Singh, K. D., Ghosh, S., & Forissier, T. (2023). Right message, right medium, right time: Powering counseling to improve maternal, infant, and young child nutrition in South Asia. Frontiers in Nutrition, 10, 1205620. https://doi.org/10.3389/fnut.2023.1205620
Capra, M. E., Decarolis, N. M., Monopoli, D., Laudisio, S. R., Giudice, A., Stanyevic, B., Esposito, S., & Biasucci, G. (2024). Complementary feeding: Tradition, innovation and pitfalls. Nutrients, 16(5), 737. https://doi.org/10.3390/nu16050737
Dagne, A. H., Zewude, S. B., & Semahegn, A. M. (2022). Appropriate complementary feeding practice and its associated factors among mothers who have children aged between 6 and 24 months in Ethiopia: Systematic review and meta-analysis. Journal of Nutrition and Metabolism, 2022, 1548390. https://doi.org/10.1155/2022/1548390
Dwijayanti, I., Al Mamun, A., Setiarsih, D., Sulistyowati, M., & Mahmudiono, T. (2024). Exploring global mothers’ knowledge, attitudes, and practice of complementary feeding: A scoping review. Nutrition, 120, 112335. https://doi.org/10.1016/j.nut.2023.112335
Gebretsadik, M. T., Tamiru, D., & Sisay, A. L. (2025). Effect of behavioural change communication through women development army on optimal complementary feeding practice among children aged 6–23 months in Southwest Ethiopia: A cluster randomized controlled trial. Nutrition Journal, 24, 116. https://doi.org/10.1186/s12937-025-01123-7
Hanindita, M. H., Widjaja, N. A., Hidayati, S. N., Irawan, R., & Hidayat, B. (2024). The use of social media as a source of complementary feeding information for mothers. The Indonesian Journal of Public Health, 19(2), 316–328. https://doi.org/10.20473/ijph.v19i2.2024.316-328
Haque, N. B., Mihrshahi, S., & Haider, R. (2023). Peer counselling as an approach to improve complementary feeding practices: A narrative review. Journal of Health, Population and Nutrition, 42, 60. https://doi.org/10.1186/s41043-023-00408-z
Herman, H., Mansur, A. R., & Chang, Y. J. (2023). Factors associated with appropriate complementary feeding: A scoping review. Journal of Pediatric Nursing, 71, e75–e89. https://doi.org/10.1016/j.pedn.2023.04.017
Intiyati, A., Edi, I. S., Soesanti, I., Christianingsih, J., Suprihatin, K., & Widarti, L. (2024). Enhancing maternal knowledge and practices in complementary feeding through emotional demonstration methods. Amerta Nutrition, 8(2SP), 49–57. https://doi.org/10.20473/amnt.v8i2SP.2024.49-57
Lincoln, Y. M., Sansuwito, T. B., Arifin, Y., & Poddar, S. (2022). The impact of nutritional counseling on complementary feeding practice and infant nutritional status at Pakan Rabaa Solok Selatan Health Centre in Indonesia. The Malaysian Journal of Nursing, 14(2), 29–36. https://doi.org/10.31674/mjn.2022.v14i02.004
Mardani, R. A. D., Wu, W. R., Hajri, Z., Thoyibah, Z., Yolanda, H., & Huang, H. C. (2024). Effect of a nutritional education program on children's undernutrition in Indonesia: A randomized controlled trial. Journal of Pediatric Health Care, 38(4), 552–563. https://doi.org/10.1016/j.pedhc.2024.02.006
Mekonen, E. G., Zegeye, A. F., & Workneh, B. S. (2024). Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey. BMC Public Health, 24, 115. https://doi.org/10.1186/s12889-023-17629-w
Moreira, P. R., Nunes, L. M. M., Giugliani, E. R. J., Gomes, E., Führ, J., Neves, R. O., Belin, C. H. S. S., & Bernardi, J. R. (2022). Complementary feeding methods and introduction of ultra-processed foods: A randomized clinical trial. Frontiers in Nutrition, 9, 1043400. https://doi.org/10.3389/fnut.2022.1043400
Nurokhmah, S., Februhartanty, J., Siscawati, M., & Hendarto, A. (2025). Women’s empowerment-related inequalities in complementary feeding practices among children aged 6–23 months in Indonesia: A decomposition analysis. BMJ Open, 15(6), e093440. https://doi.org/10.1136/bmjopen-2024-093440
Nurokhmah, S., Middleton, L., Hendarto, A., & others. (2022). Prevalence and predictors of complementary feeding practices among children aged 6–23 months in Indonesia. Journal of Preventive Medicine and Public Health, 55(6), 549–558. https://doi.org/10.3961/jpmph.22.199
Nurrika, D., Nofita, R., Septiyani, R. A., Febriyanti, H., & Sabarguna, B. (2025). Effect of a booklet media on increasing the knowledge of complementary feeding among mothers in South Tangerang, Indonesia. Journal of Nursing Practice, 9(1), 145–153. https://doi.org/10.30994/jnp.v9i1.914
Rachmah, Q., Astina, J., Atmaka, D. R., & Khairani, L. (2023). The effect of educational intervention based on Theory of Planned Behavior approach on complementary feeding: A randomized controlled trial. International Journal of Pediatrics, 2023(1), 1086919. https://doi.org/10.1155/2023/1086919
Sanghvi, T. G., Remancus, S., Frongillo, E. A., Perez-Escamilla, R., Lutter, C., Rana, P. P., Ogbodo, V., Nguyen, T., & Mathisen, R. (2025). Evidence-based lessons from two decades of implementation research on complementary feeding programmes. Maternal & Child Nutrition, 21, e13811. https://doi.org/10.1111/mcn.13811
Sarkar, P., Rifat, M. A., Bakshi, P., Talukdar, I. H., Pechtl, S. M. L., Battle, T. L., & Saha, S. (2023). How is parental education associated with infant and young child feeding in Bangladesh? A systematic literature review. BMC Public Health, 23, 510. https://doi.org/10.1186/s12889-023-15173-1
Schwarz, E. B., Hoyt-Austin, A., Fix, M., Kair, L. R., Iwuagwu, C., Chen, M. J., & colleagues. (2024). Prenatal counseling on the maternal health benefits of lactation: A randomized trial. Breastfeeding Medicine, 19(1), 45–53. https://doi.org/10.1089/bfm.2023.0219
Sethi, V., Bhanot, A., Singh, K. D., Ghosh, S., & colleagues. (2023). Right message, right medium, right time: Powering counseling to improve maternal, infant, and young child nutrition in South Asia. Frontiers in Nutrition, 10, 1205620. https://doi.org/10.3389/fnut.2023.1205620
Simbolon, D., & Suryani, D. (2024). Infant and young child feeding (IYCF) practices in rural and urban regions of Indonesia. Advances in Public Health, 2024, 6658959. https://doi.org/10.1155/2024/6658959
Titaley, C. R., Wijayanti, R. U., Mu’asyaroh, A., & Ariawan, I. (2023). The multiple factors of suboptimal early feeding practices among infants aged 0–5 months in Indonesia. Frontiers in Nutrition, 10, Article 1080727. https://doi.org/10.3389/fnut.2023.1080727
Walls, H., Pries, A., Chotivichien, S., Huynh, P., Fahmida, U., & Blankenship, J. (2023). Health first, convenience second: Caregiver perspectives of commercially produced complementary foods in five Southeast Asian capital cities. Maternal & Child Nutrition, 19(S2), e13600. https://doi.org/10.1111/mcn.13600
Weber, M. B., Palmer, W., Griffin, M., & Welsh, J. A. (2023). Infant and young child feeding practices and the factors that influence them: A qualitative study. Journal of Health, Population and Nutrition, 42, Article 32. https://doi.org/10.1186/s41043-023-00371-9
Yunitasari, E., Al Faisal, A. H., Efendi, F., Kusumaningrum, T., Yunita, F. C., & Chong, M. C. (2022). Factors associated with complementary feeding practices among children aged 6–23 months in Indonesia. BMC Pediatrics, 22, 727. https://doi.org/10.1186/s12887-022-03728-x
