Minimum Meal Frequency

Outcome

% of children 6–23 months of age who consumed solid, semi-solid or soft foods (including milk feeds for non-breastfed children) at least the minimum number of times during the previous day

Feeding meals less frequently than recommended by WHO/UNICEF (see below) can compromise a child’s total energy and micronutrient intake, which in turn may cause stunting and micronutrient deficiencies. Therefore, this indicator measures the proportion of children who consumed meals/snacks at least the recommended number of times.

There are two options for collecting the data required for this indicator. Both require conducting individual interviews with the caregivers of a representative sample of children aged 6 - 23 months:

 

1) Using Data from Measuring Dietary Diversity

If you are using the WHO/UNICEF IYCF questionnaire to measure children’s dietary diversity (see guidance), the same questionnaire also records the information needed to calculate Minimum Meal Frequency, including:

• whether the child was breastfed;

• the number of solid, semi-solid or soft food feedings; and

• relevant milk feeds for non-breastfed children.

You can use these data to determine the indicator’s value. This is the easiest option.

 

 

2) Asking Directly

If you do not use the questionnaire mentioned above, you can use the following questions:

RECOMMENDED SURVEY QUESTION (Q) AND POSSIBLE ANSWERS (A)

Q1: Yesterday, during the day or at night, was [child’s name] given any breast milk?

A1: yes / no / does not know

 

Q2: Did [child’s name] consume any soft, semi-solid or solid food yesterday, during the day or at night? (i.e. other than a fluid feed)

A2: yes / no / does not know

If yes, ask Q3:

Q3: Can you please count how many times [child’s name] ate soft, semi-solid or solid food yesterday, during the day or at night? Include meals and snacks, as well as foods such as yoghurt eaten with a spoon.

A3: _

1) ..... meals / snacks

2) does not know

 

For children whose answer to Q1 is “no” or “does not know”, also ask:

Q4a: Yesterday, during the day or at night, was [child’s name] given any infant formula? If yes, how many times?

A4a: ..... times / did not consume / does not know

Q4b: Yesterday, during the day or at night, was [child’s name] given any animal milk, such as fresh, tinned, evaporated or reconstituted powdered milk? If yes, how many times?

A4b: ..... times / did not consume / does not know

Q4c: Yesterday, during the day or at night, was [child’s name] given any liquid/drinkable yoghurt or other locally relevant fluid fermented milk product? If yes, how many times?

A4c: ..... times / did not consume / does not know

Adapt examples of formula, animal milk and fermented milk products to the local context. Yoghurt eaten with a spoon should be captured under Q3, not Q4c.

These questions provide a simplified option for routine programme monitoring. Where strict comparability with surveys using the standard WHO/UNICEF IYCF methodology is important, use the full WHO/UNICEF questionnaire.

Count the number of surveyed children who met the minimum meal frequency, which WHO/UNICEF (see below) define as:

• Two feedings of solid, semi-solid or soft foods for breastfed infants aged 6–8 months;

• Three feedings of solid, semi-solid or soft foods for breastfed children aged 9–23 months; and

• For non-breastfed children aged 6–23 months, add the number of feedings recorded in Q3, Q4a, Q4b and Q4c. The child meets the minimum meal frequency if the total is at least four and at least one feeding recorded in Q3 is a solid, semi-solid or soft food.

To calculate the indicator’s value, divide the number of children aged 6–23 months who met the minimum meal frequency by the total number of surveyed children aged 6–23 months. Multiply the result by 100 to convert it to a percentage.

Do not exclude eligible children from the denominator because of a “does not know” or missing response. For consistency with the WHO/UNICEF calculation, a “does not know” response regarding breastfeeding is treated as not breastfed, while missing feeding-frequency responses are treated as zero.

This data can be disaggregated by sex and age group (6–11, 12–17 and 18–23 months) and breastfeeding status, and if relevant and feasible, also by geographical area and household wealth. Only report disaggregated estimates where subgroup sample sizes are adequate.

1) Meal frequency may vary by season. For repeated surveys, collect data in the same season where feasible and document meaningful differences in survey timing. If a large share of the population is likely to have substantially atypical eating patterns during a prolonged fasting period, such as Ramadan, avoid that period where feasible or take the timing into account when interpreting the results.

 

2) Do not exclude, revisit or replace a sampled household simply because the child’s intake on the previous day was unusual, for example because of illness, a feast or a celebration. Such days are part of normal population-level variation. If useful, record whether intake was unusual and why as a data-quality variable.

 

3) This indicator relies on accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the data collectors should always verify the child’s age. This can be done by reviewing the child’s birth certificate, vaccination card or other document; however, since many caregivers do not have such documents (and since they can include mistakes), it is essential that your data collectors are able to verify the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors in their correct use.

 

4) Ensure that enumerators understand that feedings include both meals and snacks (e.g. fruit), but not trivial amounts.

 

5) If the design specifies that all eligible children in sampled households should be included, collect data for all of them; if children are sampled individually, collect data only for the selected child.

Also consider using the following indicators:

• Minimum Dietary Diversity - Children (captures dietary variety, which meal frequency does not)

• Minimum Acceptable Diet (combines meal frequency and dietary diversity, with an additional milk-feeding requirement for non-breastfed children)

• Minimum Milk Feeding Frequency for Non-Breastfed Children (provides the complementary milk-feeding measure for non-breastfed children)

• Continued Breastfeeding 12-23 Months (helps interpret the feeding pattern underlying different MMF thresholds)