Understanding the child feeding decisions among urban parents: a qualitative study in addis ababa, Ethiopia.

Background: Food choice decisions are complex processes influenced by various factors that affect the family's diet and, thus, their health and nutrition. In low- and middle-income countries like Ethiopia, these factors are shaped by the ongoing nutrition transition, urbanization, and socio-economic challenges. Despite growing concerns about the double burden of malnutrition, the factors influencing food choices among parents of children under five in Addis Ababa, Ethiopia, remain poorly understood. This study explores these factors.

Methods: Five focus groups with fathers and mothers (30 participants total, 5-7 per group) were conducted, along with 11 in-depth interviews with mothers of children under the age of five, for a total of 41 participants. Participants were permanent residents of Addis Ababa, having lived in the city for at least six months. Using health extension workers and community guides, participants were purposively sampled from two districts in Addis Ababa. Data were collected from November 2023 to April 2024, with interviews conducted in Amharic, audio-recorded, transcribed, and translated into English. Thematic analysis, both inductive and deductive, was performed using Bronfenbrenner's socio-ecological model as a lens.

Results: Factors influencing parental food choice were identified at three levels: individual, community, and environmental. Health concerns, affordability, child food preferences, and convenience were most frequently mentioned at an individual level. At the community level, family norms and social pressure played key roles. Food safety concerns and marketing influences were identified as important influences at the environmental level. Parents reported that while food availability was not typically a concern, changes in the food environment and economic constraints significantly impacted their food choices. They also emphasized that food safety and the reliability of food markets were essential issues.

Conclusion: This study underscores the complex, multi-level factors shaping food choices among parents of children under five in Addis Ababa. Health concerns, affordability, food safety, and market reliability were identified as key influences on food choices. These multi-level factors can guide interventions to improve children's diets by addressing individual motivations and the broader environmental contexts influencing food choices.

Clinical trial number: Not applicable.