Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran


Background: This study intended to clarify the determining factors of complementary feeding
practices among Tehran 6–24 months failure to thrive children in order to use the results for
planning the interventions to reduce the possible adverse effects. Materials and Methods: In
this study, 132 mothers of three medical and health centers were chosen by random sampling
among those centers operating under the supervision of south of Tehran District Health Center
and study data were collected from them. A valid and reliable questionnaire as a data collection
instrument developed based on behavioral analysis phase of PRECEDE model. Spearman and
Pearson’s correlation coefficient test were used to determine the statistical relationship between
factors associated with complementary feeding practices among mothers. Results: The
mothers’ knowledge was as follows: 0.8%, 20.4%, and 78.8% of them were good, medium,
and poor, respectively. Mean scores for the mothers’ performance in terms of supplementary
feeding was 66.8. Pearson correlation indicated a positive and significant correlation between
the mothers’ performance with enabling and reinforcing factors, but there wasn’t any significant
relationship between the mothers’ performance and knowledge about complementary feeding.
Conclusions: According to the obtained results, reinforcing factors, and enabling factors are
associated with the mothers’ performance in terms of complementary feeding. Hence, attention
to these issues is essential for better health interventions planning.


1. Dewey K. Introduction. In: Lutter C, editor. Guiding Principles for
Complementary Feeding of the Breastfed Child. Washington, DC:
Pan American Health Organization; 2001. p. 8.
2. Imdad A, Yakoob MY, Bhutta ZA. Impact of maternal education
about complementary feeding and provision of complementary
foods on child growth in developing countries. BMC Public Health
2011;11 Suppl 3:S25.
3. Salarkia N, Amini M, Eslami Amirabadi M, Dadkhah M,
Zowghi T, Heidari H, et al. Mother’s views and beliefs about the
role of complementary feeding in children under the age of two in
Damavand: A qualitative study. Arak Med Univ J 2010;13:63‑74.
4. Nasreddine L, Zeidan MN, Naja F, Hwalla N. Complementary
feeding in the MENA region: Practices and challenges. Nutr Metab
Cardiovasc Dis 2012;22:793‑8.
5. Patel A, Pusdekar Y, Badhoniya N, Borkar J, Agho KE, Dibley MJ.
Determinants of inappropriate complementary feeding practices
in young children in India: Secondary analysis of National Family
Health Survey 2005‑2006. Matern Child Nutr 2012;8 Suppl 1:28‑44.
6. UNICEF: Key Facts and Figures on Nutrition Report UNICEF.
c2013‑ Available from:
Key_facts_and_figures_on_Nutrition.docx. [Last accessed on 2013
Apr 15].
7. Khanal V, Sauer K, Zhao Y. Determinants of complementary
feeding practices among Nepalese children aged 6‑23 months:
Findings from Demographic and Health Survey 2011. BMC Pediatr
8. Kalantar N, Roudsari AH. Breastfeeding promotion in Iran:
Opportunities and challenges. J Compr Pediatr 2013;3:165‑6.
9. Saeidlou SN, Babaei F, Ayremlou P. Malnutrition, Overweight, and
obesity among urban and rural children in north of West Azerbijan,
Iran. J Obes 2014;2014:1‑5.
10. Tehranian S, Shojaee P, Jafarzadeh S, Kianifar HR, Jafari SA. Maternal
knowledge and practice in Mashhad City about Breast‑feeding in
First 6‑Month of Infant’s Life. Int J Pediatr 2014;2:61.
11. Mohammadhossini S, Hosseini N, Moghimi M, Fouladi M.
Knowledge and practice of mothers, regarding the supplementary
nutrition of breast‑fed infants, Yasuj, Iran. Iran J Neonatol
12. Amini M, Salarkia N, Eshrati B, Djazayery A. Poor breastfeeding as
a probable cause of childhood malnutrition: Exploring mothers’
and caregivers’ views on breastfeeding via a qualitative study in
Damavand, Iran. Razavi Int J Med 2013;1:30‑4.
13. Khaldi N, Ramezankhani A, Zayeri F, Jafari F, Davati A. Weight
faltering and major risk factors in children 2 years referred to
health centers Care East Tehran. Shahid Beheshti Med Univ
J (Pazhuhandeh) 2010;5:100‑4.
14. Aldiabat KM, Le Navenec CL. Developing smoking cessation program
for older Canadian people: An application of Precede‑Proceed
model. Am J Nurs 2013;2:33‑9.
15. Li Y, Cao J, Lin H, Li D, Wang Y, He J. Community health needs
assessment with precede‑proceed model: A mixed methods study.
BMC Health Serv Res 2009;9:181.
16. Noruzi E, Miri M, Golmohamadi SH. Factors affecting quality of life
in Birjand postmenopausal women based on behavioral analysis
phase of PRECEDE model. J Birjand Univ Med Sci 2011;19:312‑23.
17. Kashfi SM, Khani Jeihooni A. Mother’s educational program based
on the precede model on the prevention of growth retardation in
6‑12‑month old children in the health centers of Shiraz city, Fars
Province, Iran: An Interventional Study. Sci J Sch Public Health Inst
Public Health Res 2011;9:55‑62.
18. Soheyliazad A, Yeganeghasemi L, Naserkhaki V. Mothers’
knowledge and practices on complementary feeding referring to
health centers Boroojerd. J Univ Alborz 2013;2:97‑102.
19. Khoshnevisasl P, Sadeghzadeh M, Mazloomzadeh S, Koosha A,
Dariabari S. Maternal knowledge about nutritional status of 6‑12
Month old infants in the community oriented medical education of
Zanjan Univ Med Sci J 2010;18:61‑9.
20. Khazaei T, Amoozeshi Z, Ahmadi S, Safamanesh B, Mahmoodi H.
The effect of education on mother’s knowledge and practice about
supplementary nutrition for children under one year. Mod Care (Sci
Q Birjand Nurs Midwifery Fac) 2006;3:10‑4.
21. Fesharakinia A, Sharifzadeh G, Habbiby M. Evaluation of infants’
complementary nutrition pattern and some of its associated factors
in Birjand. J Birjand Univ Med Sci 2009;16:40‑6.
22. Karimi M, Ordoui M, Jamshidi KH. Maternal knowledge about infant
feeding in the first 2 years after birth in Azadshahr region of Yazd.
J Shahid Sadoughi Univ Med Sci Health Serv 2001;9:16‑23.
23. Sayari A, Parsay S, Shekholeslam R, Kolahdooz F, Farivar K,
Samadpour K, et al. nutrition requarments in children up to 6 years.
In: Kolahdooz F, Zanjani NE, Kani GS. Improving Growth and
Nutrition of Children. 3st ed. Tehran: Ministry of Health & Medical
Education & UNICEF; 2004. p. 17‑8.
24. Salarkia N, Amini M, Amirabadi ME, Dadkhah M, Zowghi T, Heidari H,
et al. Mother’s views and beliefs about the role of complementary
feeding in children under the age of two in Damavand: A qualitative
study. Arak Med Univ J 2010;13:63‑74.
25. Panahandeh Z, Dostaresanaye M. Pattern complementary feeding
and maternal knowledge in rural regions of Rasht. J Fac Nurs
Midwifery Guilan 2008;18:9‑15.
26. Joukar F, Ezbarami ZT, Yegane MR. Situation of supplementary
feeding in 6‑12 month old children in Ilam. Hayat J (Fac Nurs
Midwifery Tehran Univ Med Sci) 2008;14:61‑8.
27. Alizade FS, Azam HP, Sedighi R. Relationship between maternal
knowledge referred to health centers in Khoy and their performance
on the nutritional status of children under three years. J Urmia Nurs
Midwifery Fac 2009;7:152‑6.
28. Jalili Z, Faghihezadeh S, Heydarnia A, Hazaveie MM,
Sadathashemi SM. Using the Precede model for analysis of maternal
preventive behaviors of iron deficiency anemia in children 5‑1 years
old. J Kerman Univ Med Sci 2001;9:93‑101.