Prevalence and factors associated with minimum dietary diversity among infants and young children aged 6-23 months in Kyangwali Refugee Settlement, Kikuube District, Uganda

Abstract

Background: Minimum Dietary Diversity is a key indicator of adequate complementary feeding and optimal nutrition among children aged 6–23 months, essential for growth, development, and long-term health. In humanitarian settings such as refugee settlements, achieving MDD remains a major challenge due to socioeconomic constraints, limited food access, and weakened health and nutrition systems. Evidence on dietary diversity among refugee children in Uganda remains limited, necessitating context-specific assessment to inform targeted interventions. Objective: To determine the prevalence of minimum dietary diversity and associated factors among children aged 6–23 months in Kyangwali Refugee Settlement, Uganda. Methods: A community-based mixed-methods cross-sectional study was conducted among 273 caregivers of children aged 6–23 months and selected by using simple random sampling. Quantitative data were collected using a structured questionnaire incorporating a 24-hour dietary recall, while qualitative data were obtained through five focus group discussions with caregivers. Quantitative data were analyzed using STATA version 18. Descriptive statistics summarized participant characteristics, and multivariable logistic regression was used to identify factors associated with meeting the criteria for MDD. Qualitative data were analyzed thematically using Atlas.ti. Results: The prevalence of minimum dietary diversity among children aged 6–23 months was 4.8%. Meeting MDD was more commonly observed among children whose mothers had tertiary or university education (AOR: 1.91; 95% CI: 1.52–2.31) and among those whose caregivers had media exposure (AOR: 1.86; 95% CI: 1.39–2.90). Conversely, children of unemployed or self-employed mothers were less likely to meet MDD (AOR: 0.28; 95% CI: 0.11–0.44), as were children from larger households (AOR: 0.17; 95% CI: 0.05–0.38) and those born to unmarried mothers (AOR: 0.96; 95% CI: 0.28–0.98). Qualitative findings highlighted economic hardship, limited food availability, large family size, withdrawal of humanitarian food assistance, and inadequate household support as major barriers to achieving dietary diversity, despite caregivers’ general awareness of recommended feeding practices. Conclusion: Minimum dietary diversity among children aged 6–23 months in Kyangwali Refugee Settlement was very low. Maternal education, employment status, media exposure, marital status, and household family size were associated with dietary diversity. Interventions that strengthen maternal education, improve livelihood opportunities, enhance access to nutrition information, and reinforce food security and humanitarian support are essential to improve child feeding practices in refugee settings. Keywords: Minimum dietary diversity, Complementary feeding, Refugee children, Child nutrition, Uganda