The minimum acceptable diet (MAD) is an indicator of infant and young infant child-feeding practice (1, 2) launched by the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF), which is a combination of both the minimum meal frequency and the minimum dietary diversity. Minimum dietary diversity is a proxy for adequate micronutrient density in food and is defined as children who received five or more of the eight food groups (3, 4); whereas minimum meal frequency intake is a proxy for meeting energy requirements and is defined as daily consumption of ≥2 times for children aged 6–8 months, ≥3 times for those aged 9–23 months, and ≥ 4 times for those who were not breastfed (5, 6). A minimum acceptable diet as an indicator of infant and young child-feeding practice is a simpler, valid, and reliable method of assessing complementary feeding practice (7).

Malnutrition continues to be a major public health problem in low-and middle-income countries (8). Infants and young children are more susceptible to malnutrition, which commonly leads to child morbidity and death (9). Despite the WHO/UNICEF recommendations, most studies revealed a suboptimal rate of infant and young child-feeding practice globally (10). Analysis of the UNICEF global database report for 2024 revealed that only 21% of young children use MAD globally.¹ A synthesis of national survey data from 80 low-and middle-income countries also revealed that only 10.1% of infants and young children received MAD (9). The attainment of MAD remains a significant challenge for developing countries, particularly in sub-Saharan Africa. Ghana, as a sub-Saharan African country, is experiencing a burden of undernutrition. ² One important contributing factor to malnutrition in Ghana is inappropriate feeding practices after 6 months of age (11). Identifying potential risk factors is a crucial step toward improving infant and young children’s feeding practices in Ghana.

During the first 2 years of life or the child’s 1,000 days of life, inadequate feeding practices have a negative effect on children’s development and health. It has been determined that this time frame is the “critical window” for promoting a child’s optimal growth, health, and development. Inappropriate infant and young child-feeding (IYCF) during this period results in a significant threat to child health by impairing cognitive development, compromised educational achievement, and low economic productivity, which become difficult to reverse later in life (5, 12, 13). Although it is not usually a direct cause (7), inappropriate feeding practices during the first 2 years of life were responsible for more than two-thirds of malnutrition-related deaths (14–17). Stunted growth, limited cognitive development, and micronutrient deficiency result from inappropriate feeding practices (18, 19). To overcome undernutrition, for children who are 6 months and older, complementary feeding needs to be started (5, 12). An estimated 6% of mortality among children under five could be avoided by providing appropriate complementary feeding. Thus, concerned bodies should strive to attain minimum acceptable diet use in low-income sub-Saharan African countries, including Ghana.

As reviewed in prior literature, both individual and community-level factors are responsible for attainment of the minimum acceptable diet among young children aged 6–23 months. Accordingly, child age, child sex, birth order, plurality of birth, maternal and paternal education and occupation, wealth index, ANC visit, PNC visit, media exposure, and institutional delivery were individual-level determinants of MAD. Whereas, place of residence and regional variations account for community-level determinants (20–27).

Some countries in Africa, including Ghana, have made marginal improvements in reducing malnutrition among under-five children. However, according to the GDHS 2022 report, 18, 7, and 12% of under-five children were stunted, wasted, and underweight, respectively (21) and 59% of children do not meet the minimum diversity requirement. ³ Thus, there is a need to overcome undernutrition and improve the attainment of dietary requirements to improve young child-feeding practices. The government of Ghana, in collaboration with stakeholders, stands to reduce undernutrition, including the Ghana Nutrition Improvement Program Project, the National Nutritional Policy, School Feeding Programs, and the Start Right Feed right from birth to 2 years of life (28). Despite this, a large proportion of children are unable to attain infant and young child-feeding practices in Ghana (10).

Suboptimal infant and young children feeding practices were a major contributor to undernutrition in young children (29). Nutritional improvement through appropriate complementary feeding practices is critical for young children’s healthy growth and development (30, 31). Thus, the nutritional status of children, particularly youngsters, requires current and frequent studies to monitor their feeding practices. In addition, identifying potential predictors that lower the attainment of MAD use helps concerned bodies prioritize appropriate interventions. As far as the investigator’s search of the literature is concerned, there is a paucity of recently updated information on child attainment of the minimum acceptable diet among young children aged 6–23 in Ghana. Therefore, this study aimed at assessing the magnitude of attainment of the minimum acceptable diet and its predictors among children aged 6–23 in Ghana by using the most recent data, which will help to inform relevant authorities and identify potential barriers against attainment of the minimum acceptable diet.

Inadequate infant and young child-feeding practices are the most important global problems and the major determinates of undernutrition. To attain optimal growth and development in the first 2 years of life, young children need adequate nutrition. Identifying and reducing the disabling factors behind adequate nutrition in this critical window period is a crucial step toward improving children’s overall health and wellbeing (31, 46). To the best of our knowledge, this study is based on the most recent data to determine the magnitude and independent predictors of MAD use among children aged 6–23 months in Ghana. Thus, it provides up-to-date evidence for relevant authorities to improve the feeding practices of infants and young children in Ghana.

This study revealed that 26.40% (95% CI: 24.82–28.06) of young children aged 6–23 attain the minimum acceptable diet in Ghana. This study’s findings were lower than the studies conducted in Guinea (28%) (47), Nepal (33%) (48), Indonesia (61.8%) (49), and Bangladesh (34.7%) (50). The discrepancy might be due to geographic variation, population growth and density, and socio-economic status. Additionally, food preparation, dietary restrictions, food item selection, meal scheduling, cultural beliefs, availability and accessibility of food, and childcare practices may differ across countries (51).

However, this study found higher than the UNICEF 2022 report, studies done in East Africa (11.56%), Ethiopia (11.3%) (52), West African countries (3–11) (53), sub-Saharan Africa (9.89%), Gambia (3.2%), Rwanda (21.4%) (54), Tanzania (15.9%) (55), previous studies in Ghana (11.72%) (7), Philippines (6.7%), and India (10.5%) (56–59). ⁴ The possible explanation could be that our study, based on the most recent data, suggested that other countries might have made improvements like Ghana but have not yet reported. In addition, some of the sub-Saharan countries were at the lowest economic level as compared to Ghana’s lower-middle-income economy, since the economy had a direct impact on the nutritional status of the family, like increasing the purchasing ability of variety and quality food items for young children’s and whole households, where better nutrition might be available to the family (60). Moreover, Ghana nowadays has a mature and stable democracy, and strong media further helps citizens attain nutritional requirements by increasing productivity. Furthermore, there was a regional and global commitment to nutrition in Ghana that might bring further improvements to young children’s feeding practices in the country. ⁵ Thus, other low-income countries shall take the strategy, initiatives, and nutritional interventions used in Ghana to enhance the feeding practices of young children.

Using multi-level logistic regression analysis, the key predictors of the minimum acceptable diet were child age, household head sex, maternal and paternal education level, breast-feeding children, middle and richer wealth index, high-community poverty level, and Savanah region.

Compared to children aged 6–8 months, children aged 9–11 months and 12–23 months had higher odds of minimum acceptable diet use. This indicates that as the child gets older, there is a high probability of attaining the minimum acceptable diet. This is supported by the studies done in different parts of the world (9, 11, 61). The possible explanation could be that mothers introduced other varieties of diets in addition to breast-feeding as the child grew older, or a late initiation of complementary feeding. In addition, mothers may perceive young children’s inability to digest foods like solid, semi-solid, and soft foods like meat, eggs, fruit, and vegetables due to the unsuitability of specific food items. Some societies in the world also consider not giving some food items and animal sources of food before 12 months of age and the eruption of teeth (62–64). So, it is important to advise mothers with younger children to start complementary feeding after the baby turns 6 months old during their follow-up and postnatal checks (65, 66).

Children in the middle and richer wealth quintiles had reduced odds of the minimum acceptable diet use as compared to children residing in the poor wealth quintile. This also indicates that as the family wealth status improved, the nutritional status of children improved. This supports the study done in the Philippines and Ethiopia (52, 59). The possible explanation could be that mothers from the richest households were more likely to give their children highly nutritious food as compared to mothers from poorer households, who were more likely to focus on quantity aspects of food (67). Poor households may lack the purchasing power to provide a sufficiently varied diet to feed their children. In addition, children from households with higher incomes have better resources to meet the MAD than their counterparts from the poorest households since they are exposed to better complementary feeding practices, resulting in improved nutrient adequacy and sufficiency (59). However, it is possible to get a diversified, feasible, and healthy diet at an affordable cost using locally available foods (68, 69).

Children born from parents with higher education had a higher chance of attaining the minimum acceptable use as compared to children born from uneducated parents. This study aligns with other studies done in different parts of the world (51, 57, 70, 71). This is due to the fact that as the mother’s education level grows, her knowledge, attitude, and practice may improve. Furthermore, higher education will provide nutritional counseling and enhance child-feeding practices (13, 72). Thus, educating parents is one key strategy to improve the nutritional status of young children.

Children who received postnatal care (PNC) were more likely to meet the minimum acceptable diet than their counterparts. This is supported by other studies (12, 73). One possible explanation could be that PNC checkups allow healthcare practitioners to personalize their counseling and assistance for mothers. By addressing specific issues, dispelling myths, and providing individualized guidance on feeding habits and dietary needs, clinicians help moms make informed decisions that encourage a minimum acceptable diet for their children (22).

Children from high-poverty communities are less likely to receive the minimal recommended diet than their contemporaries. The outcomes of this investigation were consistent with prior research (59, 74). In impoverished communities, various interconnected variables contribute to the challenge of providing appropriate and healthy food for children. These include restricted financial resources, limited resources for making nutritious meals, limited storage space, cultural influences, and food preferences (75, 76). Thus, the focus of relevant bodies should be on reducing income inequality and poverty.

Children who reside in the Savannah region of Ghana have a reduced use of the minimum acceptable as compared to children residing in the Western region of Ghana. This is supported by the previous study done in the country, as there is variation in the nutritional status of children that is difficult to explain, but cultural practices of the respective region might be the cause of the variations (11). Moreover, water scarcity, land degradation, and drought are major threats to the area, with desert-prone areas being particularly hard hit. In addition, it is the most unstable location due to erratic and unexpected rainfall, which reduces crop productivity and raises the risk of food shortages, malnutrition, and related issues (77, 78).

This study also found that currently breastfed children were more likely to attain meal frequency as compared to non-breast-fed children. This is supported by the studies done in different parts of the world (67, 79). The possible explanation could be that the new minimum acceptable diet indicator incorporates breast milk as one of the components of food items that help breast-feeding children attain minimum meal frequency, dietary diversity, and the minimum acceptable diet as a whole. For instance, the Ethiopian DHS 2016 report showed that the proportion of feeding according to the minimum acceptable dietary standard is somewhat lower among non-breast-feeding children than breast-feeding children (80). Moreover, as the study done in China revealed, extended breast-feeding is associated with improved nutritional status as measured by standard anthropometric indicators (79). However, a study done in India found that extended breast-feeding (6–23 months) does not show any significant difference in impact on the anthropometric measurements of child health.

This study’s strength was the use of multi-level modeling to make meaningful inferences and findings while accounting for the clustering effect in GDHS. The study has the potential to assist programmers and policymakers in developing effective national interventions because it is based on data from a countrywide survey. However, the study has its own limitations. Due to the cross-sectional nature of the study design, the results of this study could not infer a causal relationship between outcome and independent variables. In addition, recall bias may exist in this study due to the cross-sectional nature of DHS and its reliance on respondents’ self-reports, like 24-h recall of food intake by children, which might also be affected by social desirability bias, and the frequency and diversity of the food intake may be overestimated. Moreover, prior studies also revealed inconsistent findings of MAD attainment in Ghana from 2000 until now; thus, further temporal studies showing trends should be done. Finally, due to the DHS nature of the data, important social, political, agricultural, and cultural variables are not available. Thus, future research incorporating multiple causes of the attainment of the minimum acceptable feeding practice will be done.

Even though Ghana had improvement in minimum acceptable diet use as compared to previous reports. However, many children are still far behind in receiving the minimum acceptable diet in Ghana as per the WHO-recommended standard of 90% coverage (11). Therefore, measures should be taken further to optimize MAD utilization in the country. The study also found that factors at the individual and community levels were associated with the attainment of a minimum acceptable diet. The main factors that determined the minimum acceptable diet in our study were child age, household head sex, current breast-feeding, wealth index, and region. Therefore, interventions to improve MAD use should be implemented at the individual and community levels. Thus, government policymakers and relevant authorities should give special attention to the Savannah region, male-headed households, early initiation of complementary feeding, improving breast-feeding, and improving household wealth status in Ghana.

The government of Ghana should plan and work in short terms through the program that endorses awareness creation for male-headed households to give attention to children’s feeding practices, early initiation of complementary feeding, and improving breast-feeding. Long-term plans are also needed for the Savanah region and individual-level household wealth quintiles of the country to improve infant and young child-feeding practices.