Feeding Practices and Linear Growth Faltering Among Sierra Leonean Children Aged 6 to 23 Months: A Study Using 2019 Sierra Leone Demographic Health Survey

Introduction: Linear growth faltering, a strong indicator of chronic undernutrition, is a significant public health concern in Sierra Leone, particularly among children aged 6 to 23  months. The objective of this study was to estimate the prevalence of  stunting and its relationship with infant and young child feeding (IYCF) practices with nationally representative data of the 2019 Sierra Leone Demographic and Health Survey (SLDHS). Methods: Cross-sectional study of 1,343 mothers aged 15-49 years and their youngest children aged 6-23 months. Stunting (length-for-age Z-score < -2 according to WHO criteria) was the primary outcome. Exposures included age-appropriate complementary feeding, meal frequency, dietary diversity,  and breastfeeding. Potential predictors were  identified using multivariable logistic regression after adjusting for covariates (p ≤ 0.05). Results: The prevalence of stunting was 26%. IYCF practices (breastfeeding, meal frequency, dietary diversity, complementary feeding) showed no significant association with stunting (p > 0.05). Older children (12-17 months: aOR = 2.48, 95% CI: 1.70-3.62; 18-23 months: aOR = 3.30, 95% CI: 2.22-4.93), male sex (aOR = 0.56 for female, 95% CI: 0.42-0.75) and underweight at birth increased stunting risk. Secondary maternal education (aOR = 0.60, 95% CI: 0.40-0.91), higher wealth (richest: aOR = 0.40, 95% CI: 0.17-0.92), normal/overweight maternal BMI (aOR = 0.43, 95% CI: 0.25-0.72; aOR = 0.41, 95% CI: 0.22-0.76), and urban residence (aOR = 3.44 for rural, 95% CI: 1.08-11.00) reduced the odds of stunting risk. Conclusions: Although IYCF practices were not significantly associated with stunting, socio-demographic factors were identified as significant predictors. Child's age, male sex, underweight birth weight and rural residence were associated with higher stunting risk, while maternal education,  wealth, and maternal BMI were protective. Targeted interventions that improve  maternal nutrition, economic situations, and the rural-urban gap are needed to alleviate stunting in Sierra Leone.