10. Proportion of children aged 6–23 months who receive a minimum acceptable diet (MAD)

10. Proportion of children aged 6–23 months who receive a minimum acceptable diet (MAD)

VERSION

V5.0 - 2026.03 — Existing with revisions

INDICATOR CODE

10

TECHNICAL OWNER

PRG-S Nutrition

INDICATOR TYPE

Country Level Outcome Indicator

INDICATOR CLASSIFICATION

Mandatory

INDICATOR SCOPE

Programme specific

APPLICABILITY

The selection of this indicator is mandatory against the following sub-activities in CSPs logframes. Selection of the below sub-activities will trigger in COMET the mandatory selection of this indicator:

1. Prevention of micronutrient deficiencies (PMD)

2. Prevention of acute malnutrition (PREV)

3. Prevention of stunting (STUN)

4. HIV care & treatment (HIV/TB_C&T)

This indicator is also recommended to be used under Nutrition-Sensitive activities therefore the Nutrition Sensitive Marker should be selected at sub-activity level where relevant.

The selection of this indicator is also recommended against the following sub-activities in CSPs logframes. Selection of the below sub-activities will NOT trigger the mandatory selection of this indicator:

1. Food assistance for Assets (FFA)

2. Management of moderate acute malnutrition/undernutrition (MAM)

3. General Distribution (GD)

4. Smallholder Agricultural Market Support (SMS)

UNIT OF MEASUREMENT & ANALYSIS

Percentage of children aged 6- 23 months

DEFINITION

MAD is a composite indicator used for assessing Infant and Young Children Feeding (IYCF) among children 6 – 23 months.

The Minimum Acceptable Diet is defined as:

For breastfed children: receiving at least the minimum dietary diversity and minimum meal frequency for their age during the previous day;

For non-breastfed children: receiving at least the minimum dietary diversity and minimum meal frequency for their age during the previous day, as well as at least two milk feeds.

Minimum Diet Diversity 6-23 months (MDD) definition: Percentage of children 6–23 months of age who consumed foods and beverages from at least five out of eight defined food groups during the previous day (24 hour recall).

Note: The WHO/UNICEF 2021 methodology update revised the MDD indicator to require consumption from at least five of eight food groups, with breastmilk now included as one of the eight food groups (previously 4 of 7 food groups).

Minimum Meal Frequency 6-23 months (MMF) definition: Percentage of children 6–23 months of age who consumed solid, semi-solid or soft foods (but also including milk feeds for non-breastfed children) at least the minimum number of times during the previous day (24 hour recall).

Minimum Milk Feeding Frequency for Non-Breastfed children 6-23 months (MMFF) definition: Percentage of non-breastfed children 6–23 months of age who consumed at least two milk feeds during the previous day (24-hour recall).

Breastfed children:

Non-Breastfed children:

RATIONALE

The Minimum Acceptable Diet (MAD) indicator is used to determine whether children aged 6–23 months receive diets of sufficient quality and frequency to support healthy growth and development. This age group has high nutrient requirements and is particularly vulnerable to undernutrition; therefore, measuring complementary feeding practices is essential. MAD captures the core components of appropriate feeding dietary diversity and meal frequency making it one of the most comprehensive indicators for assessing infant and young child feeding.

MAD is needed because it reflects the likelihood that children are meeting their macro‑ and micronutrient needs during the critical first 1,000 days of life, when optimal nutrition has the greatest effect on survival, cognitive development, immunity, and lifelong health. The indicator is also useful for monitoring progress toward improved child diets and identifying gaps that may contribute to wasting, stunting, and micronutrient deficiencies. It supports global and corporate commitments to reduce undernutrition, promote diet quality, and address malnutrition in all its forms, in line with strategies focused on early childhood nutrition.

DATA COLLECTION TOOL

A survey conducted among the beneficiary population, such as Post Distribution Monitoring (PDM), is the most common. A representative sample size should be used appropriately.

It is highly recommended that MAD be included in any household assessment, such as Comprehensive Food Security and Vulnerability Assessment or any other population-based representative survey.

The electronic version of the questions for this indicator can be found in Survey Designer in the Nutrition Module Minimum Acceptable Diet (MAD)sub-module or by selecting the indicator Proportion of Children 6-23 Months of Age Who Receive A Minimum Acceptable Diet (MAD).

SAMPLING REQUIREMENTS

A significant representative sample needs to be generated if a survey is conducted. The following guidance on sample size determination can be adopted for the MDD-W indicator:

• Population size is the number of individuals (i.e., children 6-23 months) enrolled in the program at the survey time.  

• Expected prevalence of the indicator: use previous prevalence if available, and if unknown, 50% can be used.  

• Non -response: 10%  

• Design effect: if cluster sampling is done, the design effect needs to be considered. This can be based on previous results and set at 1,5 if no information is available. Take note of guidance on design effect for situations where the design effect needs to be increased or decreased due to the homogeneity of the surveyed population.  

• Confidence interval highly recommended being 95%.

INDICATOR CALCULATION FOR REPORTING

The MAD indicator is a “composite” of the three indicators: the Minimum Dietary Diversity, Minimum Meal Frequency and Minimum Meal Frequency for non-Breastfed Children.

The Minimum Dietary Diversity (MDD) indicator establishes the proportion of children who consumed at least five out of the standard food groups during the previous day.

The eight food groups used for tabulation of this indicator are:

NOTE: For WFP monitoring purposes, including ACR and APR, the IYCF indicator has been recently modified to include an additional question related to the consumption of Specialized Nutritious Foods. The SNF should be categorized as flesh food.

Minimum Meal Frequency (MMF): The minimum number of times is defined 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

• Four feedings of solid, semi-solid or soft foods or milk feeds for non-breastfed children aged 6–23 months, whereby at least one of the four feeds must be a solid, semi-solid or soft feed.

OR

Minimum milk feeding frequency (MMFF) is defined as the proportion of non-breastfed children who consumed at least two milk feeds during the previous day.

Calculation of the Minimum Acceptable Diet (MAD) Indicator:

For breastfed infants, if MDD and MMF are both met, then MAD is achieved.

For non-breastfed infants, if MDD and MMF and MMFF are all met, then MAD is achieved.

This indicator is calculated in two steps.

1. The first step is to calculate the three component parts and code each part “1” for “yes, achieved” and “2” for “no” for each individual IYC, for all three component parts.

2. Once these three indicators have been calculated, then in the second step, MAD can be estimated as:

The calculation of the MAD indicator can be completed electronically with statistical software or with an excel sheet.

• For assistance in calculating MAD in an excel sheet, see here:

Scripts in R, STATA and SPSS and sample data are available on Github for the survey version of this indicator.

DATA ENTRY AND DISAGGREGATION IN CORPORATE SYSTEMS

Values are recorded in the logframe. Each value has a reporting combination which is created based on:

• Sub-activity

• Country

• Target Group

Data is entered in COMET as follows:

Note:

• It is mandatory to report Minimum Dietary Diversity (MDD); one of the indicators required to collect to calculate MAD.

• It is recommended to report: Minimum Meal Frequency (MMF) and Minimum Milk Feeding Frequency for Non-Breastfed children 6-23 months (MMFF).

MAD is a summary indicator that can be disaggregated in many ways to provide essential information on feeding practices. The analysis needs are dependent upon the results of MAD and programme needs. For more information, please see Indicators for assessing IYCF 2021.

BASELINE

Baselines are set only once, at one of the following points:

1. At the beginning of the CSP, or

2. When the indicator is selected for reporting after the commencement of the CSP; or

3. When a change in target, location and/or modality triggers a new reporting combination (target, location and modality) for an existing indicator.  

Baselines remain fixed for the entire CSP period and are not recalculated annually, unless applicable above.

Baseline value are presented in the same format as the follow-up values.

TARGET SETTING

Annual targets:

The proportion of children 6-23 months who reached MAD has increased compared to the previous year’s value. If uncertain; it is recommended to target an increase of 10%.

End of CSP target:

For nutrition-specific programming such as prevention of stunting, micronutrient, wasting and/or SBCC programming implemented more than six months, the target should be >70%. However, the target can be lower depending on the local context, and the baseline value.

For nutrition sensitive programming, the target at the end of the CSP is to increase the MAD value compared to the baseline. Only general guidance can be provided for setting targets for MAD in the context of nutrition sensitive programming, as it is not possible to recommend universal targets. The percentage of increase should thus be determined based on local context; baseline value; type of intervention implemented and its theory of change or impact pathway; scientific evidence on the impact of this type of intervention, if available; timeframe and season (especially relevant to MAD); ongoing interventions in the same area and/or events that may affect the desired outcome.

Target values are presented in the same table as the follow‑up values.

FREQUENCY OF DATA COLLECTION

Data must be collected at least twice per year in the same season. Ensure that the baseline data was collected at the beginning of the programme. If required by the programme, data can be collected across each season. This ensures a fuller understanding of seasonal patterns in diets and serves as an important baseline if repeat measurements occur in different seasons. Data entry in COMET should be inputted as as soon as values are available.

For years when a baseline is conducted, only one follow up is required.

INTERPRETATION

An increase in the Minimum Acceptable Diet (MAD) score reflects an improvement in the overall quality and adequacy of young children’s diets, indicating that more children are receiving meals with sufficient diversity and frequency to meet their nutritional needs. This suggests positive shifts in complementary feeding practices at household or community level, and may signal that programmes, counselling, or food environments are effectively supporting healthier diets for children.  

If there is no change or if values remain consistently low this should trigger a review of the context, programme design, and implementation approach. Key questions include whether families face barriers to accessing diverse foods, whether complementary feeding messages are reaching caregivers, and whether economic, seasonal, or market conditions limit the availability or affordability of nutritious foods. Persistent stagnation may indicate the need to reconsider programme strategies or strengthen support to caregivers.

A decline in MAD signals deterioration in diet quality and warrants urgent investigation into potential causes such as food price shocks, supply disruptions, environmental emergencies, shifts in household food security, or operational challenges that may be affecting access to nutritious foods or uptake of recommended feeding practices.

REPORTING EXAMPLE(S)

A nutrition survey conducted in Ethiopia in 2021 assessed complementary feeding practices among children aged 6–23 months, using the Minimum Acceptable Diet (MAD) indicator. The results showed that 43% of children consumed a minimum acceptable diet during the previous day. Disaggregated by sex, 40% of girls and 46% of boys met the MAD criteria.

Although the overall level of MAD is relatively low, the findings represent a meaningful benchmark for understanding complementary feeding practices in the survey area. The gender differences observed suggest that boys may have had slightly better access to diverse foods or more frequent feeding than girls, which may reflect household food allocation patterns, caregiver practices, or contextual factors influencing feeding behaviours.

The results highlight ongoing challenges in achieving adequate dietary diversity and meal frequency among young children both essential for meeting nutrient needs during the first 1,000 days of life. These findings point to the need for strengthened community‑based counselling, improved access to diverse complementary foods, and closer examination of potential barriers caregivers face in offering varied diets to young children. Continued monitoring through future surveys will be important for tracking improvements and assessing the effectiveness of interventions aimed at enhancing child diet quality.

INDICATORS COLLECTED & ANALYSED AT THE SAME TIME

The following indicators may be reported along with this indicator:

Individual level indicators:

• 11. Minimum Diet Diversity of women and girls (MDD-W)

• 8. Proportion of target population who participate in an adequate number of distributions (adherence)

• 7. Proportion of eligible people reached by nutrition preventive programme (coverage)

Household level indicators:

• 1. Food Consumption Score (FCS)

• 3. Reduced Coping Strategies Index (rCSI)

• 4. Livelihood Coping Strategies - Food Security (LCS-FS)

• 5. Livelihood Coping Strategies - Essential Needs (LCS-EN)

• 6. Economic Capacity to Meet Essential Needs (ECMEN)

COMPLEMENTARY QUALITATIVE RESEARCH

Qualitative approaches should be used, including Focus Group Discussions to complement quantitative data to establish reasons for the performance of the indicator. Qualitative data can, in addition, inform required actions and recommendations for improvement.

Guidance on collecting qualitative data to complement quantitative data for this indicator can be found in this methodological note. For data collection please refer to this guide.

DECISIONS DATA CAN INFORM

MAD results help WFP identify which children are most at risk of poor nutrition and where complementary feeding practices are inadequate. By highlighting regions or communities with a high prevalence of unacceptable diets, MAD data guides WFP in prioritizing resources and targeting interventions to areas with the greatest nutritional need.

The indicator also informs the design and refinement of nutrition programmes by pointing to specific gaps in dietary diversity and feeding frequency. Based on these insights, WFP can develop or adjust interventions such as providing specialized nutritious foods, strengthening behaviour change communication, or improving market and food environment support to address the underlying nutritional constraints identified through the data.

VISUALIZATION

LIMITATIONS

MAD should not be used to inform diet quality at the individual level (child). The correct use and interpretation of MAD are at the population level, i.e., for groups of children 6-23 months. Therefore, it should not be used for screening or targeting children.

FURTHER INFORMATION

Nutrition Monitoring & Evaluation Guidelines 2022-2025 | WFPgo

WFP Guidance Minimum Acceptable Diet 2022

Indicators for assessing infant and young child feeding practices: definitions and measurement meth…

Survey Designer:

• List-based questionnaire: xlsform / enketo

• Open recall questionnaire: xlsform / enketo

Indicator calculation (resources on github):

• Scripts in R, STATA and SPSS

• Sample data