Sufficient nutrition is predominant for optimal physical and cognitive development of the child. Children’s morbidity and mortality associated with undernutrition are high (1). Minimum acceptable diet (MAD) is a crucial indicator for evaluating infant and young child feeding (IYCF) practices among children aged 6 to 23 months. It encompasses two essential components: minimum dietary diversity (MDD) and minimum meal frequency (MMF) (2). MDD ensures that a child’s diet includes a variety of food groups from different nutritional categories, while MMF ensures that the child receives an adequate number of meals and snacks throughout the day (3).

Maintaining a MAD during infancy and early childhood is crucial for ensuring optimal growth and development (4). Failure to achieve MAD places young children at heightened risk of undernutrition, particularly stunting and micronutrient deficiencies. These nutritional inadequacies can lead to increased morbidity and mortality (5). Underscoring the critical importance of providing adequate and balanced diets during this critical period of life.

Undernutrition, a state of inadequate nutrient intake, is a significant contributor to child mortality, claiming the lives of nearly half of all children under the age of five (6). A substantial proportion of childhood fatalities, amounting to almost one-third, occur in the African Region and are directly attributable to malnutrition (7).

In Ethiopia, a significant proportion of child mortality, amounting to 28%, is linked to inadequate nutrition (8). Only 4% of children between the ages of 6 and 23 months receive a diverse diet encompassing four or more food groups. Moreover, the frequency of feeding sessions is also suboptimal, with only 45% of children in this age group being fed at least thrice daily (9). This alarming situation is reflected in the low prevalence of optimal feeding practices among young children.

Previous research identified various factors influencing the likelihood of children not achieving a minimum acceptable diet (MAD). These factors include residential location (10), maternal age (11), maternal education level (12), socioeconomic status (13), exposure to media messaging about healthy eating (14), maternal employment status (15), place of delivery (16), frequency of antenatal care attendance (17), and participation in postnatal care services (18).

The Sustainable Development Goals (SDGs) have targeted reducing newborn and under-five mortality by 2030, aiming for as low as 12 and 25 deaths per 1,000 live births, respectively (19). Achieving these targets hinges significantly on ensuring that children consume a minimum acceptable diet (MAD). In line with this global initiative, Ethiopia’s Ministry of Health has also adopted a comprehensive plan to address malnutrition and diet-related public health issues, recognizing their crucial role in reducing under-five mortality. The ministry’s strategy promotes MAD among children as a critical intervention for achieving this goal (20).

Despite the enormous progress made previously and the known health benefits of optimal feeding practices, increasing the number of children getting a minimum acceptable diet in developing countries like Ethiopia has become a significant challenge. Thus, recent data regarding minimum acceptable is crucial for public health practitioners and policymakers in supporting efforts toward strengthening child nutrition programs and ending all types of malnutrition in the late life of children.

Most studies on minimum acceptable diet (MAD) in Ethiopia are confined to specific districts or regions. Additionally, logistic regression is the predominant method employed to identify factors influencing MAD. Logistic regression might provide information in situations where there is no variation across the study area. However, in the field of public health, such assumptions are not always valid, particularly when it is known that variables vary across the study area (i.e., spatially non-stationary). In such cases, logistic regression becomes inadequate for providing suitable information. Thus, geographical weighted regression is better suited for addressing these challenges.

According to previous reports, approximately 89% of children in Ethiopia failed to meet MAD requirements (21). However, the geospatial distribution of MAD among children in Ethiopia remains poorly understood, hindering the development of geographically targeted interventions. Furthermore, data on hot and cold spot areas for MAD is scarce. To expedite progress toward improving child feeding practices and ending child malnutrition, understanding the geospatial distribution of MAD and its determinants among children is crucial. Thus, this study aims to better understand the spatial pattern of the level of minimum acceptable diet and its determinants among children aged 6–23 months in Ethiopia.

This study aimed to determine the geospatial pattern of level of minimum acceptable diet and its predictors among children aged 6–23 months in Ethiopia. The final analysis revealed that 89.56% of the children were unable to achieve the minimum acceptable diet. Besides, The MGWR analysis revealed that mother with no formal education, family size above five, no media access, home delivery, and no PNC checkup after delivery were found to be the determinates of level of minimum acceptable diet.

In this study majority of the child (89.56%, 95CI: 87.85–91.10%) failed to achieve the minimum acceptable diet recommended by the WHO. This finding is higher than the study done in in Nepal (71%) (33), Indonesia (52.3%) (34), and Congo (67%) (10). In contrast, the finding is lower than the study done in India (91.6%) (11), Uganda (94.7%) (35), and Guinea (96.9%) (36). However, the finding is consistent with the study done in East Africa (88.5%) (37). These observed differences could be due to various factors, such as regional variations, population growth rates, and socioeconomic disparities between the countries being compared (38). Additionally, cultural backgrounds and individual perceptions of a balanced diet can significantly impact dietary choices (14). Governmental initiatives implementing national nutrition programs focused on proper feeding practices could also play a significant role in improving child feeding practices, thereby contributing to achieving a MAD (39). Moreover, the implementation of the Baduta program by the Global Alliance for Improved Nutrition (GAIN) has contributed to improving the achievement of an acceptable minimum diet in Indonesia (40). To address this issue effectively, tailored strategies should be developed, taking into account the variations observed across different regions. Continuous monitoring and evaluation of nutritional programs are crucial for assessing their impact and making necessary adjustments. Furthermore, translating research findings into actionable insights through various dissemination channels is key for informing policy and practice, ultimately leading to improved child nutrition outcomes.

The prevalence of inadequate minimum acceptable diet among children in Ethiopia exhibits substantial geographical variation, ranging from 40 to 99%. This finding aligns with a similar study conducted in India, confirming the existence of regional disparities in child dietary practices (41). This spatial dependency of child feeding practices stems from geographical variations in cultural norms, socioeconomic status, educational attainment, and maternal healthcare utilization, all of which influence the likelihood of children achieving a minimum acceptable diet (42, 43).

Children whose mothers have no formal education were unable to achieve the minimum acceptable diet in high hotspot areas (Somali regions). Several other studies also report a positive association between mother’s educational level and meeting MAD (15, 16, 44). In high hotspot areas like the Somali regions, which have the highest women illiteracy rate (73.3%) among Ethiopia’s regions, the absence of formal education among mothers correlates with challenges in providing children with minimum acceptable diets. Firstly, socioeconomic status plays a crucial role, as mothers with no formal education often hail from lower-income backgrounds where access to nutritious food is limited due to financial constraints. In such circumstances, families may prioritize cheaper but less nutritious food options, compromising the quality of their children’s diets. Additionally, the lack of formal education may result in a deficit of nutritional knowledge among mothers, hindering their ability to make informed decisions regarding their children’s dietary needs. Without the understanding of the importance of a balanced diet and how to achieve it, mothers may unintentionally provide inadequate nutrition to their children. Moreover, societal factors such as limited access to healthcare and community resources can further exacerbate the challenge of attaining a minimum acceptable diet for these children.

In households with a family size above five, children fail to achieve the minimum acceptable diet in southern Ethiopia. Likewise, in another study, an increase in the number of children reduces the likelihood of attaining MAD (45). In southern Ethiopia, myths and misconceptions regarding family planning (46) might contribute to an increase in family size, leading to challenges in achieving the minimum acceptable diet. Moreover, factors such as unmet need for family planning in this areas (47) may also play a role. Addressing the nutritional challenges associated with family size in southern Ethiopia requires interventions that promote reproductive health education, improve access to family planning resources, and provide economic empowerment opportunities for women. These measures can help families make informed decisions about family size while ensuring the well-being of their children.

In regions with limited access to media resources, children are unable to achieve the recommended minimum acceptable diet. This is in accordance with the findings of a previous study (48), which indicated a similar trend. The lack of access to media sources among parents hinders their ability to gain adequate knowledge about food diversification and maintaining proper meal frequency, which are crucial factors in achieving the recommended minimum acceptable diet for their children. Thus, improving media access to disseminate essential nutrition-related information will improve child feeding practices.

In western Ethiopia, the practice of home delivery is the main factor hindering the achievement of the minimum acceptable diet for children. This finding aligns with the study conducted in Nepal (49). Home deliveries often lack the involvement of skilled healthcare providers who can offer guidance on proper child feeding practices, including the importance of timely introduction of complementary foods, maintaining dietary diversity, and ensuring adequate meal frequency. In western Ethiopia, it is evident that the prevalence of home delivery is high, reaching up to 80% (50). Consequently, children in households that rely on home deliveries may be more susceptible to malnutrition and its associated health complications. This underscores the need for targeted interventions to address the challenges associated with home delivery and promote optimal child-feeding practices in regions where home delivery is widespread. Improve access to healthcare facilities by investing in infrastructure and maternal health services is also crucial.

In southern and eastern Ethiopia, the failure to attend postnatal care (PNC) checkups significantly impacts children’s ability to achieve the minimum acceptable diet. These regions often face challenges such as remote locations, limited healthcare infrastructure, and cultural beliefs that may deter mothers’ from seeking healthcare services (51, 52). Consistent findings was obtained from other studies (14, 53). Mothers who forgo PNC checkups miss essential opportunities to receive comprehensive counseling and support on optimal infant and young child feeding (IYCF) practices. These checkups provide a critical platform for healthcare providers to educate mothers’ on various aspects of IYCF, including dietary diversity and meal frequency. Implementing programs that enhance PNC utilization is therefore crucial. Besides, including essential child nutritional education and demonstration in PNC checkup will be crucial to achieve MAD.

The use of nationally representative data enhances this study’s generalizability and statistical power, allowing for the application of its findings on a national scale. Additionally, the employment of SaTScan and spatial distribution analysis provides valuable insights into the geographical distribution of inadequate minimum acceptable diet. However, the study’s reliance on secondary data limits its ability to delve into the underlying causes of this phenomenon. The data may not encompass all the factors contributing to inadequate minimum acceptable diet. Furthermore, the cross-sectional nature of the data hinders the establishment of causal relationships between the explanatory variables and minimum acceptable diet. Moreover, the lack of longitudinal data prevents the study from tracking changes in achieving a minimum acceptable diet over time and identifying potential risk factors.

In Ethiopia, 89.56% of children were unable to meet the minimum acceptable diet, surpassing the global average of 84% (54). This alarming statistic underscores the urgent need for targeted interventions, particularly in high-risk areas like the Afar and Somali regions. Additionally, allocating resources to these areas is crucial to expedite progress toward enhancing child feeding practices. Mothers’ with no formal education, family size exceeding five, no media access, home deliveries, and the absence of postnatal care (PNC) checkups were found to be the determinates of inadequate minimum acceptable. Community-based initiatives to promote women’s education have a pivotal role in addressing the problem. Programs that encourage institutional deliveries and enhance the utilization of postnatal care services are also highly recommended. Moreover, managing family size can significantly contribute to achieving the minimum acceptable diet for children. Overall, addressing those contributing factors in identified geographical locations holds immense potential to improve child nutrition and foster optimal child growth.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found at: https://dhsprogram.com/.

Ethical approval was not required for the studies involving humans because The EDHS 2019 was ethically reviewed by the National Research Ethics Review Committee (NRERC) of the Ethiopian Ministry of Science and Technology. As described in the survey final report, involvement in the survey program was voluntary, and verbal agreement (informed consent) was also taken (23). The studies were conducted in accordance with the local legislation and institutional requirements.

TK: Conceptualization, Formal analysis, Methodology, Software, Writing – original draft, Writing – review & editing. BA: Methodology, Resources, Software, Validation, Visualization, Writing – review & editing. BT: Conceptualization, Data curation, Funding acquisition, Validation, Visualization, Writing – review & editing. RH: Funding acquisition, Investigation, Methodology, Project administration, Software, Supervision, Validation, Writing – original draft.