1. SPIR II RFSA | 2023 Learning Event
Barriers to appropriate complementary feeding
and the use of Ultra-Processed Foods (UPFs): A
formative qualitative study from rural Oromia
Elazar Tadesse (PhD) ACIPH

2. Overview
o Poor complementary feeding practices
o Untimely initiation of complementary foods
o Introduction of inappropriate foods
o Children’s consumption of unhealthy foods has been
identified as a new threat affecting children’s health globally
(WHO, 2020)
o Part of formative qualitative work conducted during the first
year of SPIR II learning
o Objective
o To explore the evidence around young children’s
consumption of UPFs

3. Methods
Study setting
• West and East Hararge zone, Oromia regional state, Ethiopia
• Data collection was during the fasting season of Ramadan
Study design:
Exploratory qualitative design
Study population
• Mothers and fathers and grandmothers of children aged 6 to 23
months of age,
• Community Health Workers
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4. Methodology
Eligibility criteria
• Kebeles: High or low prevalence of on-time introduction of
appropriate complementary feeding practice
• Individuals: PSNP beneficiary households; and beneficiaries
of SPIR I project
• Sample size
• 12 FGDs (5-6 participants)
• 4 FGDs each with inexperienced mothers, experienced
mothers, fathers and grandmothers.
• 4 KIIs with HEWs
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5. Methodology
• Sampling procedure
• Convenience sampling (Participants identified by WVI
and CARE)
• Participants are recruited after collecting informed
consent
Data collection procedure
• Audio recordings,
• Notes were taken during each FGD and KII
• Semi-structured interview guides
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6. Methodology
Ethical Considerations
• Ethical approval (IFPRI, EPHA)
• Informed consent documented through audio recording
Data analysis
• MAXQDA used for organizing data
• Qualitative content analysis
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7. Results and Discussion
Sociodemographic characteristics of study participants
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Characteristics Pooled
sample
(n=89)
Mothers
(n=45)
Fathers
(n=21)
Grandmother
s (n=23)
Age in years
mean (SD) 33.1 (13.1) 25.1 (5.7) 34.3 (11.1) 45.6 (12.5)
Number of under-five
children in the household
n(%)
One 27 (30.3) 16 (35.5) 5 (23.8) 6 (26.1)
Two 37 (41.6) 17 (37.8) 13 (61.9) 7 (30.4)
Three or more 25 (28.1) 12 (26.7) 3 (14.4) 10 (43.5)
Age of index child in month
mean (SD) 13.8 (5.8) 14.1 (5.6) 12.8 (6.0) 14.2 (5.8)
Sex of index child n(%)
Boy 43 (48.3) 21 (46.7) 11 (52.3) 11 (47.8)
Girl 46 (51.7) 24 (53.3) 10 (47.7) 12 (52.2)

8. Results and Discussion
1. Complementary feeding initiation practices
• Initiation of complementary feeding with liquid foods
• Delay of solid and semi-solid foods
• Both early and delayed initiation
2. Availability and access to ultra-processed foods
• Available in small shops and marketplaces
• Packaged in small affordable sizes
• Lipid nutritional supplements (LNS, branded internationally
as Plumpy Nut) available in shops and marketplaces
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9. Result and Discussion…
3. How UPFs are perceived
• Nutritious
• Suitable for initiation of complementary feeding
• Prevent malnutrition
• Reduce the amount of faeces, thus, reducing demand for
repeated cleaning
4. How UPFs are used
• Dissolved in or diluted with water
• Bottle feeding
• Added to thin porridge as a sweetener
• Advice against the use of ultra-processed foods by the
community health workers 9

10. Conclusion and Recommendations
• UPFs are widely employed as a complementary food
• Convenient and ready to use
• Sold in small packages with a minimum affordable price
• Investing in nutritional education targeting a range of caretakers
• Deploying other intersectoral or livelihoods-focused interventions
• Further research is required to
• Quantify the level of consumption of UPFs by children
• Determine the health, nutritional, and dietary effects of the pattern
currently observed
• Effect on the use of locally produced organic complemetary foods
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