Minimum dietary diversity and its associated factors among children aged 6–23 months in Mekelle, Northern Ethiopia, following the Tigray war

Abstract

Background: Despite the known impact of conflict on child nutrition, limited evidence exists on dietary diversity in urban post-conflict settings. The World Health Organization (WHO) defines Minimum Dietary Diversity (MDD) as the consumption of at least five out of the eight defined food groups in the previous 24 h. This study determined the post-war prevalence of MDD and its associated factors among children aged 6–23 months in Mekelle, northern Ethiopia. Methods: A health-facility-based cross-sectional study of 584 participants was conducted from November to December 2024 in Mekelle using proportional allocation. Sociodemographic and dietary data were collected using a 24-hour dietary recall questionnaire. Associations were assessed using multivariable logistic regression in STATA ® version 15. Missing values were imputed using single imputation, and sensitivity analyses compared complete-cases (n = 474) versus imputed cases (n = 584). Results: Only a quarter (25.2%; 95% CI: 21.6–28.7) of children aged 6–23 months in Mekelle achieved MDD. Grains (92.1%) and legumes (69.3%) were the most commonly consumed food items, while vitamin A-rich foods (26%), other fruits and vegetables (18.2%) and flesh foods (7.2%) were the least. Children aged 18–23 months were 3.2 times more likely (Adjusted Odds Ratio (AOR) = 3.2, p = 0.001) to achieve MDD than those aged 6–11 months. Children from middle- and high-income households were 6.13-fold (AOR = 6.13, p < 0.001) and 13.58-fold (AOR = 13.58, p < 0.001) more likely to meet MDD, respectively. Households with 5–8 members had 3.6-fold higher odds of providing MDD than those with 1–3 members (AOR = 3.6, p = 0.017). Children whose mothers were aged 26–35 years (AOR = 0.48, p = 0.026) and 36–42 years (AOR = 0.29, p = 0.017) had lower odds. Fathers with above-secondary paternal education (AOR = 2.58, p = 0.031) and merchant occupation (AOR = 3.17, p = 0.001) were positively associated with MDD when compared to below-secondary and government employment. Conclusions: Post-war dietary diversity in Mekelle remains low and is significantly associated with socioeconomic and demographic factors. The reduced intake of nutrient-dense foods highlights critical gaps in child nutrition. Targeted nutrition education for caregivers and interventions promoting dietary diversity are essential in conflict recovery areas.