Exploring factors influencing complementary feeding practices in Asia from parents' and caregivers' perspectives: A qualitative systematic review.

Aims: Child malnutrition remains a significant issue worldwide, particularly in developing regions like Asia. Age 6-23 months is critical for preventing malnutrition, yet numerous children within this range do not receive nutritionally sufficient complementary foods. This study aimed to explore factors influencing complementary feeding practices among Asian parents and caregivers.

Methods: Searches for this qualitative systematic review were undertaken in May-June 2023, in five databases (Medline, Cochrane, EMBASE, PubMed, and Global Health). The review included studies from Asian countries that utilised qualitative or mixed methods, published in English. Studies involving infants with pre-existing conditions or mothers with mental health conditions were excluded. The 2018 Critical Appraisal Skills Programme checklist was used to evaluate the included studies, and data were synthesised to extract key themes related to complementary feeding practices. The appraisal certainty of review findings were assessed using the GRADE-certainty of qualitative evidence approach.

Results: This review identified 14 findings from 16 studies with 955 participants. Influencing factors were categorised into four groups: individual factors (child's preferences, knowledge gaps, sources of information, the mother's self-efficacy, time constraints, insufficient breast milk), household factors (family dynamics, secondary caregivers support, economic status), socio-environmental factors (sociocultural norms, media influences, social support, access to food), and health services.

Conclusions: This study emphasises the need to consider parents' and caregivers' experiences when developing interventions. The presence of diverse factors across settings suggests customised nutrition education that considers local contexts and involves all relevant stakeholders.