Abstract

Background

Proper nutrition during early childhood is essential for healthy growth and development, yet many children, particularly in low and middle-income countries, fail to meet recommended intake levels of fruits and vegetables. This study aims to assess the factors associated with zero vegetable and fruit (ZVF) consumption among children aged 6鈥�23 months in Tanzania, using data from the 2022 Tanzania Demographic and Health Survey (DHS).

Methods

A weighted sample of 4582 children aged between 6 and 23 months were included in the study. Data cleaning, coding, and analysis were performed using STATA version 17 software. To address the hierarchical nature of the DHS data and the binary outcome variable, a multilevel mixed-effect binary logistic regression model was used. The deviance value served as a guide for determining the best-fitting model. In the subsequent multivariable multilevel binary logistic regression analysis, adjusted odds ratios were computed alongside their respective 95% confidence intervals to evaluate the strength of association, with statistical significance set at a p-value below 0.05.

Result

The overall proportion of ZVF consumption among children aged 6鈥�23 months in Tanzania was 48.34% (95% CI: 46.87, 49.81). Current breastfeeding status, maternal educational status, household wealth index, sex of the household head, and community poverty level were associated with higher odds of ZVF consumption. Meanwhile, child age, maternal employment status, father鈥檚 educational status, and media exposure were associated with lower odds of ZVF consumption.

Conclusion

Child age, current breastfeeding status, maternal educational status, maternal employment status, father鈥檚 educational status, household wealth index, sex of household, media exposure, and community poverty level were significantly associated with ZVF consumption. Efforts should focus on educating mothers about the early introduction of fruits and vegetables in children鈥檚 diets, alongside supporting breastfeeding. Tailored economic empowerment initiatives are needed in impoverished communities to improve access to nutritious foods.

Background

Ensuring children鈥檚 proper nutrition is crucial, recognizing their status as future leaders within society. Investing in their dietary necessities not only protects their health but also establishes the groundwork for their enduring success [1, 2]. The first two years of life are a crucial period of rapid growth and development, marked by heightened energy and nutrient demands. Adequate nutrition during this period is essential to avoid malnutrition and ensure optimal cognitive and physical development [3]. By the age of six months, children need additional nutrition to support their accelerated growth beyond breast milk. Incorporating vegetables and fruits into their diet is crucial for maintaining a balanced and nutritious eating pattern [4, 5].

Transitioning from exclusive breastfeeding to complementary feeding breastfeeding can lead to malnutrition in young children [4] Consequently, introducing diverse, nutrient-rich complementary foods, notably vegetables and fruits, is vital. Ensuring adequate fruit and vegetable intake for children aged 6 to 23 months is vital for promoting their healthy growth and development, laying the foundation for lifelong dietary habits, and safeguarding against future health issues [6, 7]. This challenge is compounded in low- and middle-income countries, where food insecurity and maternal health issues impact the availability and consumption of nutrient-rich foods. Addressing these factors is crucial for preventing malnutrition, promoting healthy development, and improving overall child and maternal health [8,9,10].

The World Health Organization (WHO) and the United Nations Children鈥檚 Fund (UNICEF) have recently introduced zero vegetable or fruit consumption among children aged 6鈥�23 months as an indicator for infant and young child-feeding practices [11]. Utilizing this data enables the monitoring and assessment of both national and global advancements, facilitating the formulation of policies and initiatives aimed at encouraging healthy dietary habits [11, 12]. Although there is no universal recommendation for the optimal number of servings of fruits and vegetables for infants and young children over six months, the absence of these foods from their daily diet is widely considered a marker of an unhealthy diet [11]. Globally, fruit and vegetable consumption is below recommended levels, with intake particularly low in low- and middle-income countries [13,14,15,16]. In Sub-Saharan Africa, nearly half of children are reported to have zero fruit or vegetable consumption, raising concerns about the long-term impact on child nutrition, food security, and maternal health [17].

Studies revealed that the prevalence of fruit and vegetable consumption varied across countries. About 75% of children aged 6鈥�23 months in the United States consumed vegetables and fruits [18]. The National Health and Nutrition Survey found prevalence rates ranging from 60 to 87% in Mexico [19, 20]. Studies from the Philippines showed that the prevalence of vegetable consumption among children aged 6鈥�23 months ranged from 11 to 30%, while the prevalence of fruit consumption ranged from 5鈥�14% [21, 22]. A recent study in low- and middle-income countries reported that 45.7% of children consumed zero fruits and vegetables, with the highest prevalence in West and Central Africa (56.1%) [12]. Meanwhile, in Ethiopia, 69.3% of children aged 6鈥�23 months had zero consumption of fruits and vegetables [23].

Previous studies have shown that factors such as place of residence, child age, mother鈥檚 age, maternal marital status, exposure to media, maternal educational status, maternal working status, household wealth, antenatal care visits, place of delivery, distance to the health facility, and the number of births a mother had in the past five years were significantly associated with children鈥檚 zero fruits and vegetables consumption [12, 17, 23,24,25].

Enhancing the nutritional quality of children鈥檚 diets from the age of 6 months onward is a vital and enduring strategy for improving child nutrition [11]. In Sub-Saharan African nations, inadequate consumption of fruits and vegetables continues to pose a significant and persistent challenge [26]. While the absence of fruit and vegetable consumption among children serves as one of the key indicators for evaluating infant and young child feeding practices as outlined by the WHO and UNICEF, there remains a notable gap in understanding the extent of this issue and its underlying factors. Thus, this study aimed to assess zero fruit and vegetable consumption and associated factors among Children aged 6鈥�23 months in Tanzania using the recent demographic and health survey. The study will provide essential data for targeted interventions and policy decisions, ultimately promoting healthier dietary behaviors and reducing the burden of malnutrition-related diseases. Through evidence-based findings, the study has the potential to foster long-term improvements in child nutrition and overall well-being, not only in Tanzania but also in similar contexts globally.

Method

Study design, setting, and period

The 2022 Tanzania Demographic and Health Survey (2022 TDHS) is the seventh in a series of DHS surveys in Tanzania conducted through the Demographic and Health Surveys (DHS) Program, a global program coordinated by International Classification of Functioning, Disability, and Health (ICF international). The main purpose of the 2022 TDHS and Malaria Indicator Survey (MIS) was to provide current data needed to monitor and evaluate population, health, and nutrition programs regularly. The 2022 TDHS followed a stratified two-stage sample design. The first stage involved the selection of sampling points (clusters) consisting of enumeration areas (EAs) delineated for the 2012 Tanzania Population and Housing Census (2012 PHC). The EAs were selected with a probability proportional to their size within each sampling stratum. A total of 629 clusters were selected. Among the 629 EAs, 211 were from urban areas and 418 were from rural areas. In the second stage, households were selected systematically from each cluster. The survey consists of different datasets including men, women, children, birth, and household datasets. For this study, we used the Kid鈥檚 Record dataset (KR file). A total weighted sample of 4,582 kids aged 6鈥�23 months was considered for the final analysis.

Study variables

Outcome variable

Zero vegetable or fruit consumption: Percentage of children aged 6鈥�23 months who were not fed any vegetables or fruits during the previous day. This variable was calculated based on the consumption of two food groups, namely vitamin A-rich fruits and vegetables, and other fruits and vegetables. These food groups were included in the 24-hour dietary recall used to estimate the Minimum Dietary Diversity (MDD) in the DHS dataset [12, 17, 23]. In this study, children were considered as having zero vegetable or fruit consumption (coded as 1) if they did not consume any items from either of these groups; otherwise, they were coded as 0 [27].

Independent variables

Consistent with the study鈥檚 objective and given the hierarchical structure of TDHS data where kids were nested within the cluster, two levels of independent variables were considered. At level-1 contained individual-level variables such as; Sex of the child, Age of the child, Birth order, Breastfeeding, Maternal age, Maternal educational status, Maternal employment status, Father鈥檚 educational status, Household wealth index, Number of household members, Media exposure, child feeding counseling. At level-2 the community-level variables considered in this study were Community-level educational status, Community poverty level, place of residence, and Zone.

Operational definition

Media exposure: The variable media exposure in this study is based on three variables; the frequency of listening to the radio, watching television, and reading newspapers or magazines. Specifically, women who engaged in these activities at least once in a week were categorized as having media exposure (coded as 鈥淵es鈥�), while those who did not were considered as not having media exposure (coded as 鈥淣o鈥�) [28].

Community literacy level: The percentage of women who completed primary, secondary, and higher education in each cluster. The total educational attainments of individual women determined the cluster鈥檚 overall academic standing. The groups were divided based on the national median value, resulting in one category with higher community education level and another with lower [28].

Community poverty level: The percentage of poor and poorest mothers in the cluster is specified. The proportion of poor and poorest women in each cluster was aggregated to reflect the overall poverty status within the cluster. Mothers were categorized based on their poverty level compared to the national median value [28].

Zone: Tanzania was divided into nine geographic zones. Grouping of regions into zones allows for larger denominators and smaller sampling errors for indicators at the zonal level. The zones are as follows.

Tanzania Mainland:

• Western zone: Tabora, Kigoma.

• Northern zone: Kilimanjaro, Tanga, Arusha.

• Central zone: Dodoma, Singida, Manyara.

• Southern Highlands zone: Iringa, Njombe, Ruvuma.

• Southern zone: Lindi, Mtwara.

• Southwest Highlands zone: Mbeya, Rukwa, Katavi, Songwe.

• Lake zone: Kagera, Mwanza, Geita, Mara, Simiyu, Shinyanga.

• Eastern zone: Dar es Salaam, Pwani, Morogoro.

Zanzibar: Zanzibar zone: Kaskazini Unguja, Kusini Unguja, Mjini Magharibi, Kaskazini Pemba, Kusini Pemba.

Data management and analysis

To ensure the precision of statistical analysis, we applied weightings to the data based on sampling weight, primary sampling unit, and strata. This was done with the aim of reinstating the survey鈥檚 representativeness and accounting for the sampling design when computing standard errors. Our approach was highly effective in achieving reliable statistical estimates. For data management, descriptive statistics, and multilevel binary logistic regression analysis, we utilized STATA version 17 statistical software.

To account for the clustering effects of DHS data, we utilized a multilevel binary logistic regression model to examine the association between the independent variable and zero consumption of fruits and vegetables. Before conducting the multivariable analysis, we carried out a bivariable multilevel binary logistic regression analysis to identify the variables that meet the eligibility criteria. This approach was adopted to ensure that only the most relevant variables were considered in the final analysis. By utilizing this method, we were able to control for the potential confounding effects of the variables and obtain more accurate estimates of the associations between the predictors and the outcome variable. After considering variables with a p-value less than 0.20 and those found important in literature, we included the selected variables in the multivariable multilevel binary logistic regression analysis [26, 27].

Model building

To evaluate the degree of heterogeneity among different clusters, we employed several statistical approaches, including the Likelihood Ratio (LR) test and Intra-class Correlation Coefficient (ICC). The ICC, in particular, gauges the extent of heterogeneity between the clusters by assessing the proportion of individual variation in Zero vegetable and fruit consumption among children. These statistical methods enable us to obtain a more nuanced understanding of the level of variation among the different clusters [29].

$$\text{ICC}=\sigma^{2}/(\sigma^{2}+\pi^{2}/3)$$

Four models were employed to perform multivariable multilevel binary logistic regression. The first model was a null model that didn鈥檛 include any explanatory variables, and it was designed to measure the level of cluster variation in Zero vegetable and fruit consumption. The second model was fitted with individual-level variables, while the third model was fitted with community-level variables. Finally, the fourth model was fitted with both individual and community-level variables included at the same time. Variables with a p-value less than 0.05 during multivariable analysis were identified as statistically significant predictors, and the Adjusted Odds Ratio (AOR) was reported, along with its 95% confidence interval (CI). The model鈥檚 fitness was verified by utilizing deviance, with the best-fit model being the one with the lowest deviance.

Multicollinearity was checked using generalized variance inflation factor. The Generalized Variance Inflation Factor (GVIF) is a measure used to detect multicollinearity in regression models, particularly when dealing with categorical variables. It is an extension of the standard Variance Inflation Factor (VIF) and adjusts for the degrees of freedom associated with the predictors. In essence, GVIF helps to understand how much the variance of a regression coefficient is inflated due to multicollinearity, making it more suitable for models with categorical predictors [30].

GVIF is calculated as follows:

$$\text{GVIF}=\text{VIF}^{(1/2*\text{df})}$$

Where df is the degrees of freedom for the predictor variable, which was (df鈥�=鈥�15) in the current analysis. As shown in Table听1, the GVIF values for all predictor variables in the final model were below five, indicating the absence of multicollinearity.

Table 1 Assessment of multicollinearity among predictors of zero vegetable and fruit consumption

Ethical consideration

Permission to access the data used in this study was obtained from a measure demographic and health survey through an online request from . The data are publicly available from the program鈥檚 official database.

Result

Socio-demographic and health-related characteristics

Among 4,582 children 2,389 (52.15%) of them were males, 39.32% of them were between the age of 12鈥�18 months of age, and three-fourths (75.88%) were currently breastfeeding. Furthermore, 36.98% of children reside in households, which have a poor wealth index. Regarding parent characteristics, 53.65% of mothers had primary educational status and 61.23% had formal employment. The vast majority (80.24%) of mothers didn鈥檛 receive child-feeding counseling in the last 6 months and 31.85% had no media exposure (Table听2).

Table 2 Individual & community-level characteristics of the study participants (n鈥�=鈥�4582)

Proportion of zero vegetable and fruit consumption

The overall proportion of ZVF consumption among Tanzanian children was 48.34% (95%CI: 46.87, 49.81). Regarding the distribution of ZVF consumption across the independent variables, 53.79% of females and听52.87% of 6鈥�11 months children do not consume vegetables and fruits in the past 24听h prior to the survey. Half (51.45%) currently breastfeeding children and 56.49% of children whose mothers had no formal education had ZVF consumption. The proportion of ZVF consumption among children who reside in rural households was 54.08% (Table听2).

Random effect and model comparison

Random effect analysis within the null model was utilized to explore clustering effects on ZVF. MOR of 3.94 in the null model indicates that the median increase in the odds of ZVF consumption is nearly four times when moving from a lower-risk cluster to a higher-risk cluster. To identify the factors associated with ZVF consumption, Model III encompassing both individual and community-level variables was chosen as the best-fitted model, given its lowest deviance compared to other models (3,899) (Table听3).

Table 3 Model comparison and random effect results

Table 4 Multilevel analysis of factors associated with zero vegetable and fruit consumption among Tanzanian children (n鈥�=鈥�4582)

Factors associated with zero vegetable and fruit consumption among Tanzanian children

The age of the child, maternal employment status, father鈥檚 educational status, and media exposure were found to be protective factors, while breastfeeding status, maternal educational status, wealth index, sex of the household head, and region were identified as predisposing factors.

Children whose ages were 12鈥�18 and 19鈥�23 months were 48% (AOR鈥�=鈥�0.52, 95%CI: 0.42, 0.66) and 37% (AOR鈥�=鈥�0.63, 95%CI: 0.48, 0.83) decreased odds of ZVF consumption. The odds of ZVF consumption among currently breastfeeding children were 39% (AOR鈥�=鈥�1.39, 95%CI: 1.08, 1.81) increased compared to children who are not currently breastfeeding. Compared to children whose mothers have no formal education, children whose mothers had primary education had 37% (AOR鈥�=鈥�1.37, 95%CI: 1.04, 1.81) increased odds of ZVF consumption. Children whose fathers had primary and secondary education had 45% (AOR鈥�=鈥�0.55, 95%CI: 0.37, 0.80) and 51% (AOR鈥�=鈥�0.49, 95%CI: 0.26, 0.93) decreased odds of ZVF consumption compared to their counterparts. Compared to children who live in poor households, those who live in middle and rich households had 68% (AOR鈥�=鈥�1.68, 95%CI: 1.24, 2.27) and 89% (AOR鈥�=鈥�1.89, 95%CI: 1.32, 2.73) increased odds of ZVF consumption. Children who reside in female-headed households had a 52% (AOR鈥�=鈥�1.52, 95%CI: 1.15, 2.01) increased odds of ZVF consumption compared to their counterparts. Children whose mothers had media exposure were found to have 36% (AOR鈥�=鈥�0.64, 95%CI: 0.51, 0.80) decreased odds of ZVF consumption. Children who reside in a community with a high poverty level had 3.14 times (AOR鈥�=鈥�3.14, 95%CI: 2.03, 4.87) higher odds of ZVF consumption (Table听4).

Discussion

Vegetables and fruits are vital sources of vitamins, minerals, and fiber necessary for children鈥檚 healthy growth and development. Understanding ZVF consumption helps pinpoint nutritional gaps that could lead to deficiencies and associated health problems. The study offers valuable data for public health officials to create targeted interventions and policies to enhance child nutrition and reduce malnutrition rates. Using nationally representative data, this study investigated the determinants of zero vegetable and fruit consumption among children aged 6鈥�23 months in Tanzania. Child age, current breastfeeding status, maternal educational status, maternal employment status, father鈥檚 educational status, household wealth index, sex of household, media exposure, and community poverty level were significantly associated with ZVF consumption among children between 6 and 23 months.

The overall proportion of ZVF consumption among Tanzanian children was 48.34% (95%CI: 46.87, 49.81). This finding is lower than studies conducted in Ethiopia (69.3%) [23], and West and Central Africa (56.1%) [12]. However, it surpasses findings from studies in low- and middle-income countries, where the reported global consumption of ZVF was 44.8% and 45.7% [12] The discrepancies in the proportion of consumption of ZVF across different studies and countries might be due to differences in socio-demographic characteristics, cultural preferences, economic disparities, government policies, and geographic, climate, and feeding habits of the respondents, all of which synergistically influence the types, quantities, affordability, availability, and consumption patterns of fruits and vegetables.

According to the current study children, whose ages were between 12 and 18 and 19鈥�23 months were found to have decreased odds of ZVF consumption. This is in line with a study done in 64 low and middle-income countries [12], Sub-Saharan Africa (SSA) [17] as well as Ethiopia [31]. A possible explanation could be baby-led weaning (BLW), a practice that allows babies 6 months and older to avoid pur茅es and mashed-up foods. Instead, they go right for finger foods like vegetables and fruits. BLW encourages newborns to become familiar with a wider range of textures and flavors. This exposure may eventually contribute to more diverse and healthful dietary preferences among young children [32, 33]. Children whose age is greater than 6 months are typically transitioning from breast milk or formula to solid foods. As they explore new tastes and textures, parents often introduce a variety of fruits and vegetables, leading to increased consumption. Toddlers in this age group are often more curious and willing to try new foods compared to younger infants. Their increasing independence and motor skills allow them to explore and eat a wider range of fruits and vegetables.

Compared to children who are not currently breastfeeding, children who are currently breastfeeding found to be at increased odds of ZVF consumption. One explanation is that breastfeeding infants might start eating complementary foods later than non-breastfeeding infants, leading to lower vegetable and fruit intake [34]. Another attributing factor could be maternal awareness of infant feeding. Mothers might prioritize breastfeeding and cereal-based foods over fruits and vegetables for children under one year of age [35].

A previously done study reported a strong association between maternal educational status and a child鈥檚 healthy eating behavior [17, 36]. Corroborated by previous studies our study found that compared to children whose mothers have secondary and above educational status children whose mothers had primary educational status were found to eat less vegetables and fruits. Mothers with only primary education may have restricted financial resources. As a result, they might struggle to afford a wide range of foods, including fresh fruits and vegetables. These financial limitations can affect the overall quality of their child鈥檚 diet [37]. Less educated mothers might not fully understand the nutritional benefits of consuming a variety of fruits and vegetables. Education plays a crucial role in raising awareness about the importance of balanced nutrition. When mothers lack this knowledge, they may inadvertently limit their child鈥檚 access to essential nutrients. Cultural norms and traditions significantly shape dietary choices. Less educated mothers may adhere to traditional practices passed down through generations. While a mother鈥檚 education can significantly impact her understanding of nutrition, other factors like financial resources and cultural traditions also play crucial roles in shaping the home food environment. For instance, financial constraints can limit access to healthy food options, regardless of one鈥檚 nutritional knowledge. On the other hand, cultural food traditions can often provide a wealth of nutritious recipes and practices that contribute to a healthy diet, even if formal education on nutrition is lacking. It鈥檚 a complex interplay of various elements, and understanding this can help in creating more effective strategies for improving family nutrition [38, 39].

Our study shows children whose mothers are formally employed had a decreased odd of ZVF consumption. This is similar to other studies, which examined vegetable and fruit consumption in 91 LMICs [40]. Employed women may have more financial resources, allowing them to afford an increased variety of foods, including fruits and vegetables, as well as greater access to health-related information, such as the advantages of fruits and vegetables. Workplace wellness programs and contact with colleagues might help raise awareness. Unemployed mothers may have fewer options for such exposure [42,43,43].

The current study found a protective association between paternal educational status and ZVF consumption. Children whose fathers had secondary and higher educational status were found to have decreased odds of ZVF consumption. This could be explained by the findings reported by studies done in Ethiopia [44] and Bangladesh [45], the study findings highlight an interesting association between husbands鈥� education levels and mothers鈥� knowledge regarding dietary diversity for 6鈥�23-month-old children. Specifically, mothers whose husbands had attained secondary education or higher demonstrated greater awareness of dietary diversity. This knowledge could potentially influence their choices in providing their children with a variety of vegetables and fruits. While mothers often remain the primary caregivers, fathers are increasingly involved in various aspects of child feeding. This includes decision-making about the foods available at home and interactions with the child during mealtimes [46]. Educated fathers have a higher socioeconomic status which allows families to afford a variety of foods including vegetables and fruits which contribute significantly to their children鈥檚 diet diversity and access to nutritious foods [47, 48].

In line with a study done in India [49] and a study that examined data from 125 Demographic and Health Surveys conducted in 64 countries between 2006 and 2020 [12], in the current study media exposure was associated with a decreased odd of ZVF consumption. Mothers鈥� exposure to media messages has been linked to children鈥檚 eating behaviors. Children of mothers who have access to media are less likely to consume zero vegetables or fruits. The possible explanation could be mothers who have media exposure are more likely to receive information about healthy child-feeding practices, including the importance of a diverse diet and the nutritional benefits of fruits and vegetables.

Our analysis also revealed that children living in middle and rich households had higher odds of consuming ZVF compared to those in poorer households. This could be attributed to the greater access these households have to a variety of foods, including processed and convenience options, which are often preferred over fruits and vegetables due to taste and convenience. Processed foods and fast-food chains aggressively market their products as convenient and desirable, while fresh produce receives less promotion, resulting in lower awareness or interest among these demographics. In contrast, studies also found that children from middle to rich households had decreased odds of consuming zero ZVF [12, 23, 50, 51]. Children from middle and high-income households may have better access to fruits and vegetables since their families can afford them. In contrast, lower-income families often encounter financial constraints, which restrict their access to healthy food choices. As a result, they may find it challenging to obtain nutritious foods such as fruits and vegetables.

Children who live in female-headed households were found to have increased odds of ZVF consumption compared to children who live in male-headed households. This could be because female-headed households typically have lower income levels, which can limit their capacity to afford fresh food. Furthermore, the multiple burdens of juggling work, family chores, and childcare may result in less time for meal planning and preparation.

Strengths and limitations of the study

The study endeavored to address a neglected issue, harnessing nationally representative data and employing advanced modeling to gauge variables across individual, household, and community levels. The cross-sectional design of this study prevents the determination of causal relationships. Additionally, the ZVF consumption indicator relies on the mother鈥檚 report of the child鈥檚 food intake during the day or night before the survey, which may not accurately reflect the child鈥檚 usual diet and is susceptible to both under-reporting and over-reporting.

Conclusion

The current study鈥檚 findings can guide government policies and programs aimed at enhancing child nutrition, such as subsidies for fruits and vegetables or educational campaigns. Local organizations can leverage the study to create community-based initiatives that tackle specific barriers to vegetable and fruit consumption identified in the research. The study highlights the importance of educating parents, especially mothers, about the benefits of a varied diet for their children, leading to improved feeding practices. Better vegetable and fruit consumption can result in healthier outcomes for children, reducing malnutrition, stunting, and other related health issues. Improving the nutritional status of young children can have long-term benefits, including better educational performance, higher productivity, and improved economic prospects for the future. Nearly half of children aged 6鈥�23 months in Tanzania do not consumed听vegetable and fruit. Current breastfeeding status, maternal educational status, household wealth index, sex of the household head, and community poverty level were associated with higher odds of ZVF consumption, while child age, maternal employment status, father鈥檚 educational status, and media exposure were associated with lower odds of ZVF consumption. To address the issue of ZVF consumption among children aged 6鈥�23 months in Tanzania, here are some recommendations: Promote continued breastfeeding while introducing vegetables and fruits as part of complementary feeding from 6 months of age. Educate mothers on the significance of a varied diet for their children鈥檚 growth and development. Implement community-based initiatives to combat poverty and enhance access to nutritious foods. Collaborate with local organizations to distribute food supplements and provide nutritional education. Involve fathers in nutritional education programs to highlight their role in fostering healthy eating habits. Emphasize the importance of both parents participating in their child鈥檚 nutrition. Use media platforms to spread information on child nutrition and the benefits of consuming vegetables and fruits. Create engaging and informative content to reach a broad audience, including those in rural areas. By adopting these recommendations, we can reduce ZVF consumption and improve the nutritional status of young children in Tanzania. Furthermore, Efforts should prioritize comprehensive nutrition education for mothers, emphasizing early introduction of fruits and vegetables into children鈥檚 diets alongside breastfeeding support. Economic empowerment initiatives tailored to communities facing higher poverty levels should be implemented to enhance the accessibility and affordability of nutritious foods.