Maternal Knowledge, Attitudes, and Practices Regarding Complementary Feeding Among Children Under 2 Years of Age: An Urban-Rural Comparison in Jharkhand, India

Background Appropriate complementary feeding during the period of 6-24 months is essential for meeting the growing nutritional requirements of infants that cannot be met by breast milk alone after six months of age. Maternal knowledge, attitudes, and practices (KAP) are critical determinants of infant feeding behavior. Urban-rural disparities in education, socioeconomic status, and healthcare access may contribute to differences in these practices. This study aimed to assess and compare maternal KAP regarding complementary feeding in urban and rural areas of Ranchi district, Jharkhand, using a validated scoring framework. Methods A community-based cross-sectional study was conducted among 305 mothers of children aged 6-24 months in urban Doranda (n=107) and rural Ormanjhi (n=198), the field practice areas of the Department of Community Medicine, RIMS, Ranchi. Data were collected using a pre-tested semi-structured questionnaire. KAP was assessed using a Bloom’s cut-off-based scoring system: knowledge scores were classified as good (≥80%), moderate (60-79%), or poor (<60%); attitude as positive, neutral, or negative; and practice as good, moderate, or poor. Associations were tested using the chi-square test, and ORs were calculated to describe KAP pathways. Statistical significance was set at p<0.05. Results Overall, 63.3% of mothers had good knowledge, 58.0% held positive attitudes, and 54.1% demonstrated good complementary feeding practices. Urban mothers performed significantly better across all three domains (p=0.032, p=0.041, and p=0.006, respectively). Good knowledge was strongly associated with positive attitude (OR=5.35; 95% CI: 3.23-8.86; p<0.001) and good practice (OR=4.47; 95% CI: 2.60-7.68; p<0.001). Positive attitude showed the strongest association with good complementary feeding practices (OR=5.27; 95% CI: 3.05-9.11; p<0.001). Maternal education and household income were the most significant sociodemographic determinants of KAP (p<0.001 for both). Conclusion While general awareness was relatively high, significant gaps existed in practices, particularly in rural areas. The study demonstrates a sequential pathway from knowledge to attitude to practice, with socioeconomic factors as the primary underlying determinants. Targeted nutrition education and behavior change communication through frontline health workers are essential to translate knowledge into improved complementary feeding practices.