This document summarizes a qualitative study exploring barriers to appropriate complementary feeding and the use of ultra-processed foods (UPFs) for young children in rural Ethiopia. Key findings include: 1) Complementary feeding practices varied, including both early and delayed initiation of liquids and solids. 2) UPFs are widely available, affordable, and marketed for infant feeding. 3) Caregivers perceive UPFs as nutritious and suitable for infants, helping to prevent malnutrition. 4) UPFs are used by dissolving or diluting in water and adding to thin porridges. Further research is needed to understand impacts of UPF consumption on children's health and nutrition.

1. SPIR II RFSA | 2023 Learning Event
Barriers to appropriate complementary feeding
and the use of Ultra-Processed Foods (UPFs): A
formative qualitative study from rural Oromia
Elazar Tadesse (PhD) ACIPH

2. Overview
o Poor complementary feeding practices
o Untimely initiation of complementary foods
o Introduction of inappropriate foods
o Children’s consumption of unhealthy foods has been
identified as a new threat affecting children’s health globally
(WHO, 2020)
o Part of formative qualitative work conducted during the first
year of SPIR II learning
o Objective
o To explore the evidence around young children’s
consumption of UPFs

3. Methods
Study setting
• West and East Hararge zone, Oromia regional state, Ethiopia
• Data collection was during the fasting season of Ramadan
Study design:
Exploratory qualitative design
Study population
• Mothers and fathers and grandmothers of children aged 6 to 23
months of age,
• Community Health Workers
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4. Methodology
Eligibility criteria
• Kebeles: High or low prevalence of on-time introduction of
appropriate complementary feeding practice
• Individuals: PSNP beneficiary households; and beneficiaries
of SPIR I project
• Sample size
• 12 FGDs (5-6 participants)
• 4 FGDs each with inexperienced mothers, experienced
mothers, fathers and grandmothers.
• 4 KIIs with HEWs
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5. Methodology
• Sampling procedure
• Convenience sampling (Participants identified by WVI
and CARE)
• Participants are recruited after collecting informed
consent
Data collection procedure
• Audio recordings,
• Notes were taken during each FGD and KII
• Semi-structured interview guides
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6. Methodology
Ethical Considerations
• Ethical approval (IFPRI, EPHA)
• Informed consent documented through audio recording
Data analysis
• MAXQDA used for organizing data
• Qualitative content analysis
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7. Results and Discussion
Sociodemographic characteristics of study participants
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Characteristics Pooled
sample
(n=89)
Mothers
(n=45)
Fathers
(n=21)
Grandmother
s (n=23)
Age in years
mean (SD) 33.1 (13.1) 25.1 (5.7) 34.3 (11.1) 45.6 (12.5)
Number of under-five
children in the household
n(%)
One 27 (30.3) 16 (35.5) 5 (23.8) 6 (26.1)
Two 37 (41.6) 17 (37.8) 13 (61.9) 7 (30.4)
Three or more 25 (28.1) 12 (26.7) 3 (14.4) 10 (43.5)
Age of index child in month
mean (SD) 13.8 (5.8) 14.1 (5.6) 12.8 (6.0) 14.2 (5.8)
Sex of index child n(%)
Boy 43 (48.3) 21 (46.7) 11 (52.3) 11 (47.8)
Girl 46 (51.7) 24 (53.3) 10 (47.7) 12 (52.2)

8. Results and Discussion
1. Complementary feeding initiation practices
• Initiation of complementary feeding with liquid foods
• Delay of solid and semi-solid foods
• Both early and delayed initiation
2. Availability and access to ultra-processed foods
• Available in small shops and marketplaces
• Packaged in small affordable sizes
• Lipid nutritional supplements (LNS, branded internationally
as Plumpy Nut) available in shops and marketplaces
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9. Result and Discussion…
3. How UPFs are perceived
• Nutritious
• Suitable for initiation of complementary feeding
• Prevent malnutrition
• Reduce the amount of faeces, thus, reducing demand for
repeated cleaning
4. How UPFs are used
• Dissolved in or diluted with water
• Bottle feeding
• Added to thin porridge as a sweetener
• Advice against the use of ultra-processed foods by the
community health workers 9

10. Conclusion and Recommendations
• UPFs are widely employed as a complementary food
• Convenient and ready to use
• Sold in small packages with a minimum affordable price
• Investing in nutritional education targeting a range of caretakers
• Deploying other intersectoral or livelihoods-focused interventions
• Further research is required to
• Quantify the level of consumption of UPFs by children
• Determine the health, nutritional, and dietary effects of the pattern
currently observed
• Effect on the use of locally produced organic complemetary foods
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