Complementary feeding practices and associated factors among children aged 6–23 months in Ethiopia: a systematic review and meta-analysis

Background In low- and middle-income countries, optimal complementary feeding practices for children aged 6–23 months are poorly practiced. Studies in Ethiopia report varying prevalence and factors due to differences in agro-ecological, socioeconomic, and cultural contexts. This systematic review and meta-analysis aimed to estimate the pooled prevalence and identify associated factors among Ethiopian children in this age group. Methods We conducted a comprehensive literature search using major electronic databases, including PubMed, Scopus, ScienceDirect, and HINARI. Data analysis was conducted using STATA version 17.0. Statistical heterogeneity among the included studies was assessed using Cochran’s Q statistic and quantified using the I² test, complemented by subgroup analysis and meta-regression. A random-effects model was used to estimate the pooled prevalence of complementary feeding practices and their associated factors. The results are presented using forest plots with corresponding pooled prevalence estimates, adjusted odds ratios (aOR), and 95% confidence intervals (CI). Results In this study, 20 primary cross-sectional studies were included. The pooled prevalence of appropriate complementary feeding practices among Ethiopian children aged 6–23 months was 20.61% (95% CI: 16.46, 24.76). Timely initiation of complementary feeding was observed in 78.8% of cases, whereas only 18.4% met the minimum acceptable diet criteria. Factors positively associated with appropriate complementary feeding included maternal secondary education or higher (aOR = 3.55; 95%CI: 2.01, 5.08), maternal employment (aOR = 3.25; 95%CI: 1.95, 4.54), antenatal care attendance (aOR = 4.66; 95%CI: 3.47, 5.89), and postnatal care utilization (aOR = 3.10; 95%CI: 2.06, 4.14). Additionally, children aged 18–23 months (aOR = 3.63; 95%CI:2.63, 5.87), higher household income (aOR = 4.25; 95%CI:2.63,5.87), smaller family size (aOR = 3.64; 95%CI:3.03,4.25), maternal knowledge (aOR = 5.38;95%CI:3.87,6.89), and food-secure households (aOR = 3.84; 95%CI:1.97,5.00) were significantly associated with appropriate complementary feeding practices. Conclusion The pooled prevalence of complementary feeding among Ethiopian children aged 6–23 months is low, with only one in five meeting recommended standards. While maternal education, healthcare services, nutrition knowledge, and household support are linked to IYCF practices.