Missed opportunities: Infant feeding practices and caregiver knowledge in Papua New Guinea

Infant malnutrition and sub-optimal feeding practices remain critical public health challenges in Papua New Guinea (PNG), which has the world’s fourth-highest rate of stunting, affecting nearly half of all children (1) . Despite this burden, data on mothers’ knowledge, attitudes, and practices (KAP) around infant feeding in PNG remain limited. Addressing these issues in PNG urgently requires context-specific, tailored behaviour change interventions at key stages of infant growth, to promote optimal infant and young child feeding (IYCF) practices (2) . This study assessed caregivers’ nutritional KAP to inform the design of context-specific, evidence-based interventions in PNG.A mixed-methods design was used, combining an interview-assisted questionnaire with 66 mother-parent dyads and a Yumi Tok Stori approach with 44 mothers. The target population was mothers of infants aged 7-9 months, recruited from Simbu Province and Eastern Highlands. Both methods explored nutritional knowledge, attitudes, and infant feeding practices. Infant and young child feeding (IYCF). Dietary adequacy indicators, including Minimum Acceptable Diet (MAD), Minimum Dietary Diversity (MDD), and Minimum Meal Frequency (MMF), were determined based on the World Health Organisations’ guidelines (3) . The mean infant age was 7.8 months (SD 1.3). Breastfeeding initiation was nearly universal (97%), yet 64% of mothers did not practice exclusive breastfeeding. While 61% knew that exclusive breastfeeding facilitates infant growth and survival for the first six months, and 67% correctly identified 6 months as the appropriate age to start complementary feeding, knowledge of animal-source foods was low. Only 42% identified eggs as suitable for infants at 6 months, and fewer than 20% recognised that fish or chicken was appropriate at this age. In terms of feeding practices, only 35% of infants met the MAD. MDD was achieved by 47% (mean [SD] of 4.5 [1.6] food groups), while MMF was achieved by 70% (mean of 2.4 [SD 1.2] meals per day). Most mothers (84.9%) knew that sugar should not be added to infants’ food and drink, yet 46% reported their infant had consumed a sugar-sweetened drink the previous day. Awareness of multiple micronutrient powders (MNPs) was very low, with only 4 (6%) mothers having heard of them, and just 1 reported their use. Although awareness of some feeding recommendations was high, exclusive breastfeeding practices were not widely practised, knowledge of animal-source foods was limited, and fewer than 4 in 10 infants met the MAD. Very low MNP awareness highlights missed opportunities to address micronutrient deficiencies through proven interventions. This study provides critical evidence on caregivers’ KAPs, which can now inform the design of context-specific targeted education and community-based support to strengthen complementary feeding and improve infant nutrition in PNG.