Background

Nutritional imbalances in early childhood are particularly critical, as children need energy- and nutrient-dense foods for healthy growth, alongside optimal breastfeeding [9–11]. Deficiencies during the first 1,000 days can lead to delayed cognitive development and alter the body’s ability to regulate energy and store fat, increasing the risk of chronic diseases later in life [12]. These nutritional shortfalls can also negatively impact academic performance and household economic stability, perpetuating the cycle of poverty [13,14]. In LMICs, about two-thirds of child deaths are linked to poor feeding practices, including inadequate dietary diversity [15,16]. Nutritional deficiencies, such as anemia, affect 58% of children under five, while approximately 200 million children globally experience stunting and wasting, with the problem being especially severe in African countries [17,18].

The WHO highlights the significant impact of maternal feeding practices on children’s dietary diversity, emphasizing the need for dietary alignment between mothers and their children [19]. Given that mothers play a crucial role in their children’s health, enhancing maternal nutrition is vital to breaking the cycle of intergenerational malnutrition [20]. Research identifies various factors affecting children’s dietary diversity, including maternal education, household wealth, location, media exposure, household size, parity, and access to postnatal care [21–24].

In LMICs, efforts to combat malnutrition have primarily focused on improving agricultural productivity, food quality, and micronutrient fortification programs [25,26]. However, there is increasing acknowledgment of the necessity to prioritize maternal nutrition in nutritional interventions. Extensive studies demonstrate that a mother’s diet significantly influences her child’s health and development by affecting breast milk quality, prenatal nutrition, and the child’s eating habits [27–29]. Therefore, promoting maternal nutrition is essential for enhancing maternal and child health outcomes, underscoring the need for targeted policies and programs focused on maternal diets.

Despite the crucial role of maternal and child nutrition, few countries have nationally representative dietary intake surveys. To our knowledge, there is a dearth of evidence on the concordance between mother and child dietary diversity and its associated factors in Sub-Saharan Africa (SSA). Therefore, we aimed to examine the magnitude of concordance in mother-child dietary diversity and its associated factors in SSA, using data from the Demographic and Health Surveys (DHS).

Methods and materials

Results

Descriptive characteristics of study participants

A total of 29,138 women of reproductive age were included in the survey over the five years preceding the study. The majority of study participants were from Nigeria (31.66%) followed by Burkina Faso (11.63%). Approximately 71.25% of the mothers were aged between 20 and 34 years. About 40.06% of the participants had no formal education, and around 22.74% lived in low-income households (Table 1).

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Table 1. Descriptive characteristics of women aged 15-49 in eight sub-Saharan African countries.

https://doi.org/10.1371/journal.pone.0318493.t001

Dietary consumption pattern of mothers and children

Approximately 40% of mothers and 83.15% of children consume staple foods. About one-third (33.64%) of mothers incorporate pulses, such as beans and lentils, into their diets. Approximately 24.53% of both mothers and children reported consuming nuts in the past 24 hours. In terms of meat, poultry, and fish, around 63.29% of mothers and 38.40% of children indicated that they had eaten these foods. Nearly 60% of mothers included dark green leafy vegetables in their diets, while around 39.42% of children consumed fruits and vegetables rich in Vitamin A within the last 24 hours (Table 2). Almost 70% (20,667) of women and 82% (24,466) of children did not meet the minimum dietary diversity requirements. Conversely, approximately 30.72% (9,166) of women and 18.00% (5,369) of the sample consumed at least five different food groups.

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Table 2. Proportion of food groups consumption of mothers and children in the previous 24 hours in eight sub-Saharan African countries.

https://doi.org/10.1371/journal.pone.0318493.t002

Proportion of mother-child pair dietary diversity concordance

The dietary diversity concordance among mother-child pairs in Sub-Saharan Africa (SSA) was found to be 74.48% (95% CI: 73.98, 74.98). Of these pairs, 62.81% had both the mother and child consuming a limited variety of foods (≤ 5 food groups). In contrast, 11.53% of the pairs exhibited high dietary diversity for both the mother and child (Table 3).

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Table 3. Minimum dietary diversity concordance between mothers and children aged 6 – 23 months.

https://doi.org/10.1371/journal.pone.0318493.t003

Factors associated with maternal and child dietary diversity concordance

We evaluated whether the mixed-effect binary logistic regression model offered a better fit than the single-level binary logistic regression model by using the Likelihood Ratio (LR) test. The LR test yielded statistically significant results (p < 0.05), indicating that the multilevel model fit better than the single-level model. A bivariable analysis was performed between the outcome variable and several explanatory variables, including maternal education, media exposure, household wealth status, twin pregnancies, the number of household members, and the child’s sex. Variables with a p-value less than 0.2 in the bivariable analysis were considered for inclusion in the multivariable logistic regression model. The final model was adjusted for these selected explanatory variables. The odds of dietary diversity concordance between mother-child pairs were 1.42 times higher (AOR = 1.42, 95% CI: 1.31, 1.53) for mothers with primary education compared to those with no education. In contrast, the odds of concordance in dietary diversity were 25% lower (AOR = 0.75, 95% CI: 0.66, 0.88) for mothers with higher education compared to those with no education. The odds of concordance in dietary diversity for mother-child pairs were 19% lower (AOR = 0.81, 95% CI: 0.74, 0.88) for mothers from poorer households, 18% lower (AOR = 0.82, 95% CI: 0.75, 0.89) for those from middle-income households, 20% lower (AOR = 0.80, 95% CI: 0.73, 0.88) for those from richer households, and 25% lower (AOR = 0.75, 95% CI: 0.67, 0.83) for those from the wealthiest households, compared to mothers from the poorest households. Additionally, the odds of concordance were 22% lower for mothers with media exposure compared to those without it (AOR = 0.78, 95% CI: 0.73, 0.83). The odds of dietary diversity concordance with their children in mothers who were divorced or widowed were 1.54 times (AOR = 1.54, 95% CI: 1.29, 1.84) compared to single mothers (Table 4).

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Table 4. Multilevel binary logistic regression analysis of factors associated with maternal-child dietary diversity concordance in SSA.

https://doi.org/10.1371/journal.pone.0318493.t004

Discussion

We found a strong relationship between mothers and children’s dietary diversity in SSA (Kappa = 0.3189, p < 0.001, and an overall level of agreement of 74.35%). It was supported by studies reported in developing countries [24,33], the findings may be attributed to the implementation of health extension programs and the formation of health development armies in several African countries. These initiatives are designed to educate communities about various health interventions, including maternal and child nutrition practices. The results suggest a well-documented association between mothers with access to diverse diets and their children achieving minimum dietary diversity, and vice versa. This strong correlation between mothers’ and children’s dietary diversity may explain the high level of agreement observed between the two groups’ MDD.

About three-fourths of mother-child pairs had concordant dietary diversity patterns in SSA. It was lower than a previous study [34]. In sub-Saharan African countries, deep-rooted poverty often limits families’ ability to afford a diverse diet for both mothers and children [35]. As a result, mothers frequently prioritize their children’s nutrition, which can lead to significant differences in dietary diversity patterns between mothers and their children [36]. Moreover, variations in the magnitude of minimum dietary diversity concordance between mothers and children may be influenced by the different number of food groups used to calculate dietary diversity for each group. Additionally, the economic conditions of these countries can exacerbate these disparities, as limited access to a variety of foods further widens the gap in dietary diversity between mothers and their children.

Maternal educational status, household wealth status, marital status, and media exposure were significantly associated with concordance in dietary diversity between mothers and their children. Mothers with primary education were more likely to exhibit dietary diversity concordance with their children compared to mothers without formal education. However, mothers with higher education levels had lower odds of achieving concordant dietary diversity with their children compared to those without formal education. It was supported by previous studies [33,34,37], the observed association may be explained by the fact that mothers with higher levels of education could be more engaged in various activities, leaving them with less time for optimal childcare [38]. Tailored interventions aimed at this group may help address micronutrient deficiencies in children. In contrast, mothers with a primary level of education tend to show higher trust in information and greater awareness of dietary practices compared to women without formal education [39].

Mothers belonging to the poorer, middle, richer, and richest households had lower odds of dietary diversity concordance with their children compared to mothers belonging to the poorest households. It is consistent with studies reported in Nigeria [21] and Senegal [40]. In poor households, there is often less access to a variety of foods, leading to simpler and more homogeneous diets for both mothers and children [41]. As a result, their diets tend to align more closely. Additionally, in low-income households, mothers may be more directly involved in meal preparation and food selection, creating a stronger link between their dietary habits and those of their children. In wealthier households, there is generally greater access to diverse foods, and dietary patterns may differ between mothers and their children due to factors like varied food preferences, higher consumption of processed or convenience foods, and potentially less direct involvement of mothers in meal preparation [42]. This can lead to a mismatch in the dietary diversity between mothers and their children, as children may be more exposed to different food environments, such as eating at school or with caregivers, where their diet may differ from their mothers.

Mothers who had media exposure had lower odds of dietary diversity concordance with their children. It was in line with previous studies [16,43], it could be because media exposure can introduce mothers to a variety of nutritional information, but not all of it may be accurate or contextually relevant [44]. Some media content could promote unhealthy eating habits, focus on convenience foods, or emphasize modern diets that deviate from traditional, more diverse dietary practices. Additionally, exposure to media might lead to time constraints, as mothers may spend more time engaging with media, reducing the time spent preparing balanced and diverse meals for their children. This could ultimately result in a disconnect between what the mother consumes and what she provides for her children, leading to lower dietary diversity concordance.

Another significant predictor of dietary diversity concordance among mothers-child pairs was marital status. Being divorced or widowed increased the odds of having dietary diversity concordance with their children compared to single women. It was consistent with studies reported in Ghana [24] and SSA [45], it could be due to divorced or widowed women having higher odds of aligning their dietary diversity with their children’s compared to single women, potentially due to increased responsibilities or prioritization of family health after the loss of a partner, which may influence their food choices and household meal planning.

The findings of this study should be interpreted in light of the following strengths and weaknesses. First, it was based on a nationally representative sample of eight Sub-Saharan African (SSA) countries to investigate factors associated with dietary diversity concordance among mothers and children aged 6–23 months, allowing the results to be generalized to similar populations in SSA. Second, except a few food groups, the same food groups were assessed for both mothers and their children, enabling a direct comparison of maternal and child dietary diversity.

On the other hand, this study utilized a cross-sectional DHS survey, which limits our ability to infer causal relationships between factors and dietary diversity concordance. Additionally, dietary data was collected using a 24-hour recall, which introduces the possibility of recall bias and social desirability bias. A further limitation is the reliance on the 24-hour recall method, which may affect the accuracy of the reported food intake. Moreover, we acknowledge the limitation that our study relies solely on quantitative data from the DHS and lacks qualitative insights into cultural, religious, and social factors influencing dietary diversity.

Conclusions

This study found a moderate concordance between child and maternal dietary diversity in Sub-Saharan Africa (SSA), with approximately three-fourths of the dietary diversity between mothers and children being concordant. Factors such as maternal education, household wealth, marital status, and media exposure were significantly associated with dietary diversity concordance. These findings highlight the need for targeted policy interventions aimed at promoting community-based education on the importance of dietary diversity for both mothers and children, particularly for women from economically advantaged households. Policies should focus on improving access to diverse and nutritious foods, especially in low-income and rural areas. Furthermore, there is a pressing need to enhance the quality and relevance of information on dietary diversity, ensuring that it is culturally appropriate, accessible, and effectively communicated to mothers across different socio-economic backgrounds. By addressing these factors, policies can help reduce disparities in dietary diversity and improve overall health outcomes for mothers and children in SSA.