Complementary Feeding Practices and Child Undernutrition Among Children Aged 6–23 Months in Sierra Leone: A Facility-Based Cross-Sectional Study

Background: Suboptimal complementary feeding remains an important challenge for child nutrition in Sierra Leone, with national evidence indicating low attainment of recommended infant and young child feeding indicators. Aim: This study examined complementary feeding practices, child nutritional status, and maternal feeding knowledge and reported dietary practices among children attending the MSF-supported Hangha Hospital in Kenema District, Sierra Leone. Method: We conducted a facility-based cross-sectional study between January and December 2025. Consecutive sampling was used to recruit 422 mothers of children aged 6-23 months. Data were collected using a structured interviewer questionnaire adapted from WHO/UNICEF infant and young child feeding guide, with nutritional status classified using the WHO Anthro software. Descriptive and bivariate analysis was performed, followed by multivariable logistic regression of the composite outcome of any undernutrition (stunting, wasting, or underweight) with statistical significance set at p<0.05. Results: Among 422 mother-child pairs, stunting affected 24.9% of children, wasting 21.3% and underweight 25.1%; 44.1% had at least one anthropometric deficit. Complementary feeding practices were severely inadequate with only 23.7% meeting the minimum dietary diversity criterion and 7.1% meeting the minimum acceptable diet standards. Although 68.5% of mothers demonstrated high feeding knowledge, only 26.4% of mothers in this group reported feeding practices that met the minimum dietary diversity criterion. High maternal knowledge was nevertheless positively associated with achieving minimum dietary diversity (AOR 1.68, 95% CI 1.04-2.71). In the multivariable analysis of any undernutrition, maternal education (AOR 0.58, 95% CI 0.38-0.89), employment (AOR 0.54, 95% CI 0.35-0.83), exclusive breastfeeding (AOR 0.35, 95% CI 0.24-0.52), and minimum dietary diversity (AOR 0.41, 95% CI 0.26-0.65) were associated with lower odds of the composite outcome. Conclusion: Suboptimal complementary feeding practices and high burden of undernutrition was observed among children attending the study facility. Maternal feeding knowledge was associated with dietary diversity, but most children did not meet the minimum dietary diversity criterion, suggesting that knowledge alone may be insufficient to achieve optimal feeding practices. Maternal education, employment or self-employment, exclusive breastfeeding, and dietary diversity were associated with lower odds of any undernutrition. Further longitudinal and intervention research is needed to examine the observed knowledge-practice gap to improving complementary feeding and child nutrition.