Undernutrition is a contributing cause of child morbidity and mortality worldwide (1, 2). Adequate nutrition is vital for the proper health and development of children (3). The age range of 6–23 months presents a critical window to address childhood malnutrition as it is a period marked by growth faltering and increased nutritional needs that necessitate energy-dense and nutrient-rich foods (4). The nutritional value of food is paramount to the health and wellbeing of families, especially children who need essential nutrients to help them grow, develop, and reach their full physical and cognitive potential (5).

Minimum meal frequency (MMF), one of the complementary feeding indicators, is utilized as a proxy indicator for evaluating a child’s energy requirements and emphasizes the number of times that children of different ages are offered meals other than breast milk and breastfeeding (6, 7). Non-breastfed children should be given four or five meals throughout the day, incorporating both milk feeds and solid or semisolid feeds and allowing for one to two snacks on the basis of their individual preferences (8–10).

Enhancing infant and young child feeding (IYCF) practices is recognized as a critical component in enhancing child survival rates and fostering optimal growth and development (11–13). Inadequate infant and young child feeding practices during the first 2 years of life have detrimental consequences, including irreversible stunting, impaired cognitive development, and a substantial increase in the risk of both chronic and infectious diseases (14).

Ensuring appropriate complementary feeding practices is crucial for enabling the growth and development of children (15). Suboptimal complementary feeding practices in infants and children can increase the likelihood of undernutrition, illness, and mortality (16). The likelihood of malnutrition in infants and young children increases significantly after the age of 6 months (4). Common childhood illnesses such as diarrhea and infections, along with high nutritional requirements beyond breast milk, are crucial for maintaining a child’s normal development (4).

To achieve one of the targets of goal two of the sustainable development goal (SDG), which is ending all forms of malnutrition, complementary feeding practices, including MMF, should be appropriate, as they are the major determinants of malnutrition (17). The presence of nutritional deficiencies in the first 2 years of life can lead to impaired cognitive development, compromised educational outcomes, and reduced economic productivity (18, 19). Children suffering from malnutrition are more prone to illness and endure the lifelong consequences of inadequate nutrition, which may have intergenerational effects (18, 20).

In numerous countries worldwide, fewer than one-fourth of infants aged 6–23 months fulfill the criteria for dietary diversity and feeding frequency, resulting in only a few children being provided nutritionally adequate and diverse foods (21). Worldwide, about half of all children are not provided MMF, and even in the wealthiest households in regions such as West and Central Africa, Eastern and Southern Africa, and South Asia, the proportion of children who consume the recommended minimum meals per day is quite low (22). According to a publication on 49 national surveys from low-and middle-income countries on dietary quality, SSA had the lowest proportion of children aged 6–23 months that met three complementary feeding indicator requirements, including MMF, which was 41% (23). Ensuring adequate meal frequency poses a challenge in numerous developing countries, particularly in regions with low household food security, such as Sub-Saharan Africa.

The first 1,000 days of life are crucial for rapid growth, neurodevelopment, high nutritional needs, heightened sensitivity to programming effects, and increased vulnerability (24). Ensuring children’s nutritional wellbeing and improving their overall health is cost-effective through increasing meal frequency and diversity during the critical window period (25). Regularly meeting MMF can help prevent wasting (acute malnutrition) and reduce the risk of stunting (chronic malnutrition). For example, a study found that the prevalence of stunting was higher in children aged 6–8 months, highlighting the impact of inadequate complementary feeding on child growth (26). MMF, a key risk factor for stunting, is an easily measurable indicator that provides immediate feedback about feeding practices, enabling prompt, actionable responses such as education, behavior change programs, and policy interventions to prevent malnutrition.

In SSA, efforts have been made to decrease undernutrition and enhance IYCF practices. The Accelerating Nutrition Improvements (ANI) scale-up initiative was implemented in partnership with the Ministry of Health and WHO in Ethiopia, Uganda, and Tanzania (27). Interventions involving behavior change strategies significantly improved maternal and child nutrition outcomes by educating caregivers about optimal IYCF practices (28). However, SSA showed a prevalence level below half for MMF, with Western and Central Africa at 39.6% and Eastern and Southern Africa at 45.1% (29). Studies have been conducted on the factors associated with MMF in different countries across SSA (5, 14, 30–32). Nevertheless, these studies had limitations on generalizability to the regional context. The present study sought to address this gap and make a generalizable regional comparison using the most recent demographic and health survey (DHS) data in SSA. This study aims to contribute to the global debate on MMF by providing a detailed analysis of the magnitude and contributing factors. Our study not only identified the key individual and contextual determinants but also offered recommendations for policymakers. By filling the gaps, the study expected to increase understanding of how to improve minimum recommended meal frequency practices, thereby supporting global efforts to reduce malnutrition and promote better health outcomes for children.

This study examines minimum meal frequency and its determinants among children aged 6–23 months in Sub-Saharan African countries. It revealed that the pooled prevalence of MMF in SSA was 38.47% (95% CI: 34.97–41.97). This is consistent with studies from SSA among 32 countries between 2010 and 2016 (41.9%) (42), SSA among 32 countries between 2010 and 2020 (41.2%) (43), and India (41.5%) (44). This finding is lower than those of studies conducted globally (52.2%) (22), in 80 low-and middle-income countries (56.2%) (29), China (75.1%) (45), and Pakistan (84.7%) (46). This discrepancy might be due to the limited access to nutritious food in SSA as it is challenging in terms of food security. In addition, poverty, economic constraints, and conflict in the region make it difficult for families to provide regular meals for their children.

The factors that were significantly linked to MMF were marital status, sex of the household head, education level, working status, wealth index, media exposure, age of the child, postnatal check-up, current breastfeeding, residence, and region in SSA. Children aged 6 to 23 months whose mothers were married were more likely to receive MMF, which is consistent with the findings of a study from Benin (47). This could be attributed to the fact that married mothers usually get support from their spouse, family, or community, resulting in adequate practices regarding feeding their children (48). Compared with children of male household heads, children of female household heads were less likely to receive MMF, which is consistent with the findings from Gambia (31). This might be because if a woman is the head of the household, she will bear the majority of the family’s responsibilities. Consequently, she may need to spend considerable time away from home to fulfill the family’s needs or work. As a result of these factors, along with other underlying circumstances, the chance of her spending time outside the home is high, which may lead to her inability to provide the recommended MMF for her child (31).

Compared with children whose mothers had no formal education, those whose mothers had secondary education and above had an increased prevalence of receiving MMF. This finding is congruent with the findings from previous studies in Ghana (5), Ethiopia (10), SSA (43), Gambia (31), Indonesia (49), and Bangladesh (50). A possible explanation is that uneducated mothers are unable to read health education materials provided while visiting health facilities, whereas educated mothers might read leaflets, magazines, or books, which increases their chance of obtaining nutritional education, as evidenced in a study based in Nepal (51). Furthermore, they are more flexible in their ability to acquire new knowledge and modify their behavior quickly with respect to healthy child feeding practices.

Our findings also revealed that the working status of the mother and the household wealth index are significant determinants of MMF among infants and children in SSA. Children of working mothers and middle or rich households were more likely to receive MMF than children of non-working mothers and poor households, respectively. This finding parallels the postulations of previous studies (30, 31, 49, 50, 52, 53). This could be due to the fact that working mothers have their own income and can provide for their children whether they obtain financial support from their partners or not (5). Compared with poor households, rich and middle households do not have a problem with food availability, as they are food secure, which increases the likelihood of giving food to children (30, 52). Children of mothers who were exposed to media were more likely to receive MMF than those whose mothers had no media exposure, which is supported by previous studies (50, 52, 54). Messages obtained from media are more easily adopted and enhance proper feeding practices as they are considered credible sources of health and nutritional information (55).

In this study, we found that children aged 18–23 months were more likely to receive MMF than those aged 6–11 months. This observation is in accordance with the findings from previous research (5, 30, 31, 49). The possible justification might be that older children have the ability to ask for or obtain food from family members and even from the community and that the discontinuation or decreased frequency of breastfeeding as children grow older increases their chances of eating food. All these factors ensure that they meet the minimum requirement for a daily meal (5, 31). Children who received a postnatal check-up within 2 months after delivery were more likely to receive MMF than children with no postnatal check-up. This finding aligns with the results of previous studies (30, 52, 56, 57). This is because postnatal care clinics deliver information that increases knowledge about appropriate complementary feeding practices as part of the counseling service. Health professionals also advise mothers about the consequences of inappropriate child feeding practices as it can lead to morbidity and mortality (30, 58).

We found a statistically significant association between residence and MMF, in which the prevalence of MMF was higher among rural residents. Children from urban areas have better access to healthcare services, diverse food options, maternal education, and ideal family size. However, urban poverty and inequality made the urban advantage not distributed equally, and individuals living in urban poverty have a compromised right to food (59). The regions in Africa also play a role in determining the minimum meal frequency among infants and young children. Compared with living in the Central Africa region, living in Eastern and Southern Africa regions was associated with increased prevalence of receiving MMF among children. It was also revealed that children who were breastfeeding were more likely to receive MMF than their counterparts. This finding is in line with a previously conducted study (7). This might be because the frequency of meals for breastfeeding children is lower than that for non-breastfeeding children. To meet the requirements for MMF, non-breastfeeding children are advised to consume a minimum of four meals per day, whereas breastfeeding children have at least one fewer meal.

The pooled prevalence of minimum meal frequency among children aged 6–23 months in Sub-Saharan Africa was 38.47%, which is low. This poses a significant challenge for preventing malnutrition and achieving health-and nutrition-related SDGs. To improve the MMF, infant and young child feeding policies should be strengthened by monitoring and evaluating these policies. The factors that were significantly associated with MMF were marital status, maternal education, sex of household head, maternal working status, wealth index, media exposure, child age, postnatal check-up, breastfeeding status, and SSA region. The study recommends promoting breastfeeding according to WHO guidelines and postnatal check-ups within 2 months after delivery. Children aged 6–11 months and those from low-income households should also be targeted to encourage feeding with MMF by providing support to families. Women should be empowered in various aspects of life, including social and economic spheres. Enhancing women’s education and financial independence through an increased number of educated, working mothers is crucial for improving the nutritional and health outcomes of both mothers and their children. The collective work of various implementing agencies such as governments, non-governmental organizations, and community groups is essential for the success and sustainability of these initiatives.