{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:36:17Z","timestamp":1790732177246,"version":"4.1.0"},"reference-count":79,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Public Health, Sefako Makgatho Health Sciences University, South Africa"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Objective: The aim of this study was to assess complementary feeding practices and dietary diversity in relation to the nutritional status of children under five attending health facilities in the Thabazimbi sub-district, Limpopo Province. Methods: A cross-sectional study was conducted among 409 mother\u2013child pairs. Data on socio-demographics, feeding practices, and anthropometry were collected using validated tools. Nutritional status was assessed using WHO growth standards, and dietary diversity was evaluated using WHO infant and young child feeding (IYCF) indicators and a 24 h dietary recall. Associations were analyzed using prevalence ratios in STATA 18. Results: Among 409 children (median age: 18 months, IQR: 12\u201324), 38% were stunted, 13% were underweight, 5% were thin, and 17% were overweight\/obese. Exclusive breastfeeding was reported in 27%, and only 24% met the minimum dietary diversity (DDS \u2265 4). Complementary feeding practices varied significantly by maternal age, with mixed feeding more common among older mothers and younger mothers more likely to receive feeding advice (p = 0.001). Stunting was associated with being a boy (PR = 1.27; 95% CI: 1.00\u20131.61), age &gt; 24 months (PR = 0.33; 95% CI: 0.16\u20130.65), and DDS \u2265 4 (PR = 0.72; 95% CI: 0.52\u20130.99). Underweight was more prevalent among boys (PR = 2.40; 95% CI: 1.40\u20134.11), but less likely in children with DDS \u2265 4 (PR = 0.43; 95% CI: 0.20\u20130.92) and those from spouse-headed households (PR = 0.33; 95% CI: 0.13\u20130.87). Thinness was associated with DDS \u2265 4 (PR = 2.70; 95% CI: 1.13\u20136.45) and age 12\u201324 months (PR = 2.80; 95% CI: 1.02\u20137.64). Overweight\/obesity was linked to age 12\u201324 months (PR = 1.94; 95% CI: 1.25\u20133.03) and household income &gt; ZAR 15,000 (PR = 4.09; 95% CI: 2.33\u20137.17). Conclusions: Complementary feeding and dietary diversity deficits contribute significantly to the dual burden of malnutrition in rural Limpopo, highlighting the need for targeted, context-specific nutrition interventions.<\/jats:p>","DOI":"10.3390\/nu17111919","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T11:55:52Z","timestamp":1748951752000},"page":"1919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Nutritional Challenges Among Children Under Five in Limpopo Province, South Africa: Complementary Feeding Practices and Dietary Diversity Deficits"],"prefix":"10.3390","volume":"17","author":[{"given":"Tshilidzi","family":"Mafhungo","sequence":"first","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2148-7439","authenticated-orcid":false,"given":"Lindiwe Priscilla","family":"Cele","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mmampedi","family":"Mathibe","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8339-9875","authenticated-orcid":false,"given":"Perpetua","family":"Modjadji","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa"},{"name":"Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa"},{"name":"Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2342654","DOI":"10.1001\/jamanetworkopen.2023.42654","article-title":"Economic Growth and Childhood Malnutrition in Low- and Middle-Income Countries","volume":"6","author":"Heemann","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/s13643-021-01756-9","article-title":"School-based interventions targeting double burden of malnutrition and educational outcomes of adolescents in low- and middle-income countries: Protocol for a systematic review","volume":"10","author":"Shinde","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Mkhize, M., and Sibanda, M. (2020). A Review of Selected Studies on the Factors Associated with the Nutrition Status of Children Under the Age of Five Years in South Africa. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17217973"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.1017\/S136898002400137X","article-title":"Biochemical assessment of the nutritional status of infants, children and adolescents in South Africa (1997\u20132022): A systematic review","volume":"27","author":"Malan","year":"2024","journal-title":"Public Health Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1017\/S1368980022000350","article-title":"Nutritional status of school-age children and adolescents in low- and middle-income countries across seven global regions: A synthesis of scoping reviews","volume":"26","author":"Wrottesley","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_6","unstructured":"WHO (2021). Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods, World Health Organization and the United Nations Children\u2019s Fund (UNICEF). Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240018389."},{"key":"ref_7","unstructured":"UNICEF (2023). Child Malnutrition, World Health Organization. Available online: https:\/\/data.unicef.org\/topic\/nutrition\/malnutrition\/."},{"key":"ref_8","unstructured":"UNICEF, and WHO (2023). Levels and Trends in Child Malnutrition: UNICEF\/WHO\/World Bank Group Joint Child Malnutrition Estimates: Key Findings of the 2023 Edition, WHO."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Apostolopoulou, A., Tranidou, A., Tsakiridis, I., Magriplis, E., Dagklis, T., and Chourdakis, M. (2024). Effects of Nutrition on Maternal Health, Fetal Development, and Perinatal Outcomes. Nutrients, 16.","DOI":"10.3390\/nu16030375"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/mcn.12088","article-title":"Contextualising complementary feeding in a broader framework for stunting prevention","volume":"9","author":"Stewart","year":"2013","journal-title":"Matern. Child Nutr."},{"key":"ref_11","unstructured":"WHO (2024, February 12). Stunting in a Nutshell. Available online: https:\/\/www.who.int\/news\/item\/19-11-2015-stunting-in-a-nutshell."},{"key":"ref_12","first-page":"S129","article-title":"Complementary feeding: A critical window of opportunity from six months onwards","volume":"26","author":"Kruger","year":"2013","journal-title":"S. Afr. J. Clin. Nutr."},{"key":"ref_13","first-page":"36","article-title":"A review of complementary feeding practices in South Africa","volume":"33","author":"Sayed","year":"2018","journal-title":"S. Afr. J. Clin. Nutr."},{"key":"ref_14","first-page":"36","article-title":"Infant feeding practices of mothers and nutritional status of infant","volume":"21","author":"Mushaphi","year":"2008","journal-title":"S. Afr. J. Clin. Nutr."},{"key":"ref_15","first-page":"16","article-title":"Breastfeeding, complementary feeding and nutritional status of 6\u201312-month-old infants in rural KwaZulu-Natal","volume":"20","author":"Faber","year":"2007","journal-title":"S. Afr. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Modjadji, P., Seabela, E.S., Ntuli, B., and Madiba, S. (2023). Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021513"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Modjadji, P., and Mashishi, J. (2020). Persistent Malnutrition and Associated Factors among Children under Five Years Attending Primary Health Care Facilities in Limpopo Province, South Africa. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17207580"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Christian, A.K., Afful-Dadzie, E., and Marquis, G.S. (2023). Infant and young child feeding practices are associated with childhood anaemia and stunting in sub-Saharan Africa. BMC Nutr., 9.","DOI":"10.1186\/s40795-022-00667-9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12986-025-00919-y","article-title":"Variation of continued breastfeeding by age of the child among children aged 12\u201323 months: Evidence from 21 sub-Saharan African countries","volume":"22","author":"Mekonen","year":"2025","journal-title":"Nutr. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Mekonen, E.G., Zegeye, A.F., and Workneh, B.S. (2024). Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: A multilevel analysis of the recent demographic and health survey. BMC Public Health, 24.","DOI":"10.1186\/s12889-023-17629-w"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/mcn.12146","article-title":"Poor dietary diversity and low nutrient density of the complementary diet for 6-to 24-month-old children in urban and rural KwaZulu-Natal, South Africa","volume":"12","author":"Faber","year":"2016","journal-title":"Matern. Child Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Modjadji, P., Molokwane, D., and Ukegbu, P.O. (2020). Dietary Diversity and Nutritional Status of Preschool Children in North West Province, South Africa: A Cross Sectional Study. Children, 7.","DOI":"10.3390\/children7100174"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e92","DOI":"10.1017\/jns.2023.78","article-title":"Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa","volume":"12","author":"Motadi","year":"2023","journal-title":"J. Nutr. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1079\/PHN2005912","article-title":"Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy?","volume":"9","author":"Steyn","year":"2006","journal-title":"Public Health Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s41043-022-00337-3","article-title":"Does the high dietary diversity score predict dietary micronutrients adequacy in children under 5 years old? A systematic review","volume":"42","author":"Kheirouri","year":"2023","journal-title":"J. Health Popul. Nutr."},{"key":"ref_26","first-page":"303","article-title":"Dietary Diversity Score: A Measure of Nutritional Adequacy or an Indicator of Healthy Diet?","volume":"3","author":"Ty","year":"2016","journal-title":"J. Nutr. Health Sci."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dello Russo, M., Formisano, A., Lauria, F., Ahrens, W., Bogl, L.H., Eiben, G., De Henauw, S., Hebestreit, A., Intemann, T., and Hunsberger, M. (2023). Dietary Diversity and Its Association with Diet Quality and Health Status of European Children, Adolescents, and Adults: Results from the I. Family Study. Foods, 12.","DOI":"10.3390\/foods12244458"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ba, D.M., Ssentongo, P., Gao, X., Chinchilli, V.M., Richie, J.P., Jr Maiga, M., and Muscat, J.E. (2022). Prevalence and determinants of meeting minimum dietary diversity among children aged 6\u201323 months in three sub-Saharan African Countries: The Demographic and Health Surveys, 2019\u20132020. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.846049"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Harper, A., Goudge, J., Chirwa, E., Rothberg, A., Sambu, W., and Mall, S. (2022). Dietary diversity, food insecurity and the double burden of malnutrition among children, adolescents and adults in South Africa: Findings from a national survey. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.948090"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102789","DOI":"10.1016\/j.foodpol.2024.102789","article-title":"Diet quality and micronutrient intakes in nutritional value chains: A synthesis and suggestions for further research","volume":"130","author":"Meenakshi","year":"2025","journal-title":"Food Policy"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Modjadji, P., and Madiba, S. (2019). The double burden of malnutrition in a rural health and demographic surveillance system site in South Africa: A study of primary schoolchildren and their mothers. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7412-y"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Modjadji, P., Masilela, L.N., Cele, L., Mathibe, M., and Mphekgwana, P.M. (2022). Evidence of Concurrent Stunting and Obesity among Children under 2 Years from Socio-Economically Disadvantaged Backgrounds in the Era of the Integrated Nutrition Programme in South Africa. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912501"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1079\/PHN2005786","article-title":"Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa","volume":"8","author":"Mamabolo","year":"2005","journal-title":"Public Health Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s10654-011-9622-1","article-title":"STrengthening the reporting of Observational studies in Epidemiology\u2014Molecular Epidemiology (STROBE-ME): An extension of the STROBE statement","volume":"26","author":"Gallo","year":"2011","journal-title":"Eur. J. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Kieser, M. (2020). Methods and Applications of Sample Size Calculation and Recalculation in Clinical Trials, Springer.","DOI":"10.1007\/978-3-030-49528-2"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Masilela, L.N., and Modjadji, P. (2023). Child Nutrition Outcomes and Maternal Nutrition-Related Knowledge in Rural Localities of Mbombela, South Africa. Children, 10.","DOI":"10.3390\/children10081294"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Modjadji, P., and Madiba, S. (2019). Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16173021"},{"key":"ref_38","unstructured":"WHO (2008). Indicators for Assessing Infant and Young Child Feeding Practices (Part 1), World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/43895."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"WHO (2006). WHO Child Growth Standards based on length\/height, weight and age. Acta Paediatr. Suppl., 450, 76\u201385.","DOI":"10.1111\/j.1651-2227.2006.tb02378.x"},{"key":"ref_40","unstructured":"WHO (2023). WHO Guideline for Complementary Feeding of Infants and Young Children 6\u201323 Months of Age, World Health Organization. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/373358\/9789240081864-eng.pdf."},{"key":"ref_41","unstructured":"FAO (2024, February 13). Guidelines for Measuring Household and Individual Dietary Diversity. Available online: https:\/\/www.fao.org\/fileadmin\/user_upload\/wa_workshop\/docs\/FAO-guidelines-dietary-diversity2011.pdf."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1093\/jn\/137.2.472","article-title":"Dietary Diversity Score Is a Useful Indicator of Micronutrient Intake in Non-Breast-Feeding Filipino Children2","volume":"137","author":"Kennedy","year":"2007","journal-title":"J. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Norton, K. (2018). Standards for Anthropometry Assessment, International Society for the Advancement of Kinanthropometry (ISAK).","DOI":"10.4324\/9781315385662-4"},{"key":"ref_44","unstructured":"WHO (1995). Physical Status: The Use and Interpretation of Anthropometry, WHO. Report of a WHO Expert Committee 1995."},{"key":"ref_45","unstructured":"Weir, C., and Jan, A. (2025, May 25). Classification Percentile and Cut Off Points, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK541070\/."},{"key":"ref_46","first-page":"241","article-title":"The impact of the social grants programme on household vulnerability to food insecurity in South Africa: Application of a two-stage least squares and implications","volume":"13","author":"Mthethwa","year":"2023","journal-title":"Afr. J. Dev. Stud. (Former. AFFRIKA J. Politics Econ. Soc.)"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Ralston, M., Schatz, E., Menken, J., G\u00f3mez-Oliv\u00e9, F.X., and Tollman, S. (2015). Who Benefits-Or Does not-From South Africa\u2019s Old Age Pension? Evidence from Characteristics of Rural Pensioners and Non-Pensioners. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13010085"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1007\/s10995-014-1624-7","article-title":"Maternal age and risk of labor and delivery complications","volume":"19","author":"Krauss","year":"2015","journal-title":"Matern. Child Health J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"100698","DOI":"10.1016\/j.gfs.2023.100698","article-title":"Refrigerator ownership and child health and nutrition in low- and middle-income countries","volume":"37","author":"Karlsson","year":"2023","journal-title":"Glob. Food Secur."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"112571","DOI":"10.1016\/j.socscimed.2019.112571","article-title":"Housing as a determinant of health equity: A conceptual model","volume":"243","author":"Swope","year":"2019","journal-title":"Soc. Sci. Med. (1982)"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Akombi, B.J., Agho, K.E., Merom, D., Renzaho, A.M., and Hall, J.J. (2017). Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006\u20132016). PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177338"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s10935-024-00766-2","article-title":"Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions","volume":"45","author":"Wand","year":"2024","journal-title":"J. Prev."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Akombi, B.J., Agho, K.E., Hall, J.J., Wali, N., Renzaho, A.M.N., and Merom, D. (2017). Stunting, Wasting and Underweight in Sub-Saharan Africa: A Systematic Review. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14080863"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"907","DOI":"10.4102\/sajs.v108i5\/6.907","article-title":"Overweight and obesity in children and adolescents: The South African problem","volume":"108","author":"Rossouw","year":"2012","journal-title":"S. Afr. J. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1017\/S1368980023001994","article-title":"Anthropometric nutritional status of children (0\u201318 years) in South Africa 1997\u20132022: A systematic review and meta-analysis","volume":"26","author":"Kruger","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(19)32472-9","article-title":"The double burden of malnutrition: Aetiological pathways and consequences for health","volume":"395","author":"Wells","year":"2020","journal-title":"Lancet"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e003161","DOI":"10.1136\/bmjgh-2020-003161","article-title":"Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life: A systematic review","volume":"6","author":"Kelsey","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Makwela, M.S., Mashaba, R.G., Ntimana, C.B., Seakamela, K.P., and Maimela, E. (2024). Barriers and enablers to exclusive breastfeeding by mothers in Polokwane, South Africa. Front. Glob. Women\u2019s Health, 5.","DOI":"10.3389\/fgwh.2024.1209784"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12939-021-01441-2","article-title":"Breastfeeding inequities in South Africa: Can enforcement of the WHO Code help address them?\u2014A systematic scoping review","volume":"20","author":"Vitalis","year":"2021","journal-title":"Int. J. Equity Health"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s13006-020-00315-7","article-title":"Reported infant feeding practices and contextual influences on breastfeeding: Qualitative interviews with women registered to MomConnect in three South African provinces","volume":"15","author":"Trafford","year":"2020","journal-title":"Int. Breastfeed. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10995-015-1805-z","article-title":"Factors Affecting Exclusive Breastfeeding among Women in Muheza District Tanga Northeastern Tanzania: A Mixed Method Community Based Study","volume":"20","author":"Maonga","year":"2016","journal-title":"Matern. Child Health J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e008467","DOI":"10.1136\/bmjopen-2015-008467","article-title":"Trends in complementary feeding indicators in Nigeria, 2003\u20132013","volume":"5","author":"Ogbo","year":"2015","journal-title":"BMJ Open"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Seabela, E.S., Modjadji, P., and Mokwena, K.E. (2023). Facilitators and barriers associated with breastfeeding among mothers attending primary healthcare facilities in Mpumalanga, South Africa. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1062817"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Kubeka, Z., and Modjadji, P. (2023). Association of Stunting with Socio-Demographic Factors and Feeding Practices among Children under Two Years in Informal Settlements in Gauteng, South Africa. Children, 10.","DOI":"10.3390\/children10081280"},{"key":"ref_65","first-page":"100267","article-title":"A critical look at exclusive breastfeeding in Africa: Through the lens of diffusion of innovation theory","volume":"14","author":"Oyelana","year":"2021","journal-title":"Int. J. Afr. Nurs. Sci."},{"key":"ref_66","first-page":"192","article-title":"Sociodemographic factors associated with mixed-feeding practices among a cohort of mothers with infants aged 4\u201314 weeks in Tlokwe subdistrict, North West Province, South Africa","volume":"16","author":"Semenekane","year":"2022","journal-title":"S. Afr. J. Child Health"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Martin, M. (2017). Mixed-feeding in humans: Evolution and current implications. Breastfeeding: New Anthropological Approaches, Routeledge.","DOI":"10.4324\/9781315145129-10"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"407","DOI":"10.4314\/wsa.v33i3.180611","article-title":"Nutrition in contemporary South Africa","volume":"33","author":"Faber","year":"2007","journal-title":"Water SA"},{"key":"ref_69","unstructured":"Kruger, S.H., Labadarios, D., Swart, R., Maunder, E., Gericke, G.J., Kuzwayo, P.M., Ntsie, P.R., Steyn, N.P., Schloss, I., and Dhansay, M.A. (2008). National Food Consumption Survey-Fortification Baselin (NFCS-FB-I), Nutrition, Department of Health."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/03670244.2019.1598980","article-title":"Consumption of Traditional and Indigenous Foods and Their Contribution to Nutrient Intake among Children and Women in Botswana","volume":"58","author":"Kasimba","year":"2019","journal-title":"Ecol. Food Nutr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1504\/IJFSNPH.2009.029279","article-title":"Dietary diversity, nutrition status and morbidity of pre-school children in Matungu division, Western Kenya","volume":"2","author":"Ekesa","year":"2009","journal-title":"Int. J. Food Saf. Nutr. Public Health"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Keyata, E.O., Daselegn, A., and Oljira, A. (2022). Dietary diversity and associated factors among preschool children in selected kindergarten school of Horo Guduru Wollega Zone, Oromia Region, Ethiopia. BMC Nutr., 8.","DOI":"10.1186\/s40795-022-00569-w"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Khamis, A.G., Mwanri, A.W., Ntwenya, J.E., and Kreppel, K. (2019). The influence of dietary diversity on the nutritional status of children between 6 and 23\u2009months of age in Tanzania. BMC Pediatr., 19.","DOI":"10.1186\/s12887-019-1897-5"},{"key":"ref_74","first-page":"7","article-title":"An Assessment of Dietary Diversity and Nutritional Status Austin Journal of Nutrition and Food Sciences","volume":"2","author":"Potts","year":"2014","journal-title":"Austin J. Nutr. Food Sci."},{"key":"#cr-split#-ref_75.1","doi-asserted-by":"crossref","unstructured":"Asmare, A.A., and Agmas, Y.A. (2022). Determinants of coexistence of stunting, wasting, and underweight among children under five years in the Gambia","DOI":"10.21203\/rs.3.rs-1520926\/v1"},{"key":"#cr-split#-ref_75.2","unstructured":"evidence from 2019\/20 Gambian demographic health survey: Application of multivariate binary logistic regression model. BMC Public Health, 22."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s12187-020-09782-0","article-title":"Does Household Income Affect children\u2019s Outcomes? A Systematic Review of the Evidence","volume":"14","author":"Cooper","year":"2021","journal-title":"Child Indic. Res."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1007\/s13679-020-00400-2","article-title":"Socioeconomic Status and Childhood Obesity: A Review of Literature from the Past Decade to Inform Intervention Research","volume":"9","author":"Vazquez","year":"2020","journal-title":"Curr. Obes. Rep."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. 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