Cognitive Dissonance and Nutritional Paradox: Analysis of Determinants of Nutritional Status and the "Know-Do" Gap among Children Aged 6 to 24 Months in the Avé Prefecture (Togo)
Dagadou Dotse Nukunu
School of Medical Assistants (EAM), University of Lomé, Lomé, Togo.
Dégbé Mlatovi *
Laboratory of Biochemistry Applied to Nutrition and Food Sciences, Faculty of Science, University of Lome, 01 B.P. 1515, Lome, Togo.
LAWSON-DRACKEY Afua Massan Enyae Mamy EKLOU
Department of Food Science and Food Technology, Higher School of Biological Techniques (ESTBA-UL), University of Lome, 01 B.P. 1515, Lome, Togo.
PAKA Essodolom
Togolese Agricultural Research Institute (ITRA), Lomé, Togo.
Mamatchi Melila
Laboratory of Biochemistry Applied to Nutrition and Food Sciences, Faculty of Science, University of Lome, 01 B.P. 1515, Lome, Togo.
Kou'santa Amouzou
Laboratory of Biochemistry Applied to Nutrition and Food Sciences, Faculty of Science, University of Lome, 01 B.P. 1515, Lome, Togo.
*Author to whom correspondence should be addressed.
Abstract
Aims: To analyze the anthropometric determinants of nutritional status and evaluate the mechanism of cognitive dissonance (the "Knowledge-Practice" gap) regarding Infant and Young Child Feeding (IYCF) practices among mothers in a mixed rural/peri-urban setting.
Study Design: A descriptive and analytical cross-sectional study.
Place and Duration of Study: The study was conducted in the Avé Prefecture (Togo), stratified across four health facilities (two urban/peri-urban and two rural), between April and July 2025.
Methodology: The study recruited 197 mother-child dyads (children aged 6 to 24 months) via facility-based systematic random sampling. Sociodemographic data, hygiene practices, and dietary intake (24-hour dietary recall) were collected using structured questionnaires. Anthropometric nutritional status was assessed using WHO 2006 Growth Standards to calculate Z-scores for Stunting (Length-for-Age), Wasting (Weight-for-Length), and Underweight (Weight-for-Age). Statistical associations were analyzed using Pearson’s Chi-square test with a significance threshold of p < 0.05.
Results: A significant paradox was observed between maternal knowledge and actual practices. While 95.4% of mothers were aware of the Exclusive Breastfeeding (EBF) standard, 79.2% introduced complementary foods or fluids before six months. Minimum Dietary Diversity (MDD) was achieved by only 25.4% of children, with a significant disparity favoring urban areas (p < 0.05). The prevalence of malnutrition was characterized by stunting (11.2%), underweight (10.2%), and wasting (8.1%). Additionally, child hand hygiene before meals was neglected in 99% of cases, despite high maternal personal hygiene rates.
Conclusion: High maternal cognitive assimilation of nutritional norms does not guarantee behavioral adherence. Combating malnutrition requires moving beyond vertical health education to implement multisectoral interventions that target the energy density of complementary foods and ensure secure Water, Sanitation, and Hygiene (WASH) environments to sever the infection-malnutrition cycle.
Keywords: Infant and Young Child Feeding (IYCF), cognitive dissonance, knowledge-practice gap, complementary feeding paradox, anthropometric indices, protein-energy malnutrition, nutritional literacy