Influence of caregiver practices and nutrition knowledge on child nutrition in food-insecure urban coastal communities of Moratuwa, Sri Lanka

Background: Food insecurity is a critical determinant of child malnutrition in low-and-middle-income countries. Sri Lanka’s recent economic crisis has intensified household food insecurity, particularly in urban coastal populations, yet little research has examined the influence of caregiver practices and nutrition knowledge on child nutritional outcomes. 
Objectives: To assess how caregiver practices and nutrition knowledge influence child nutritional outcomes and mediate the relationship between food insecurity and malnutrition in urban coastal households of Moratuwa, Sri Lanka. 
Method: A cross-sectional study was conducted among 150 households with children aged 24–59 months, selected via stratified random sampling. Data were collected using structured questionnaires (socio-economic data, caregiver practices, nutrition knowledge), the Household Food Insecurity Access Scale (HFIAS), and anthropometric measures (WAZ, HAZ, MUAC). Analysis with SPSS V26 included descriptive statistics, chi-square tests, t-tests, and mediation analysis was done using the Baron & Kenny approach. 
Results: Forty two percent of households were moderately and 38% severely food insecure. There was 28% stunting, 22% underweight, and 18% wasting. Caregiver practices varied, 62% providing ≥3 meals/day, 58% practising good hygiene, and 64% attending nutrition workshops. Hygiene practices were significantly associated with stunting (χ²= 10.24, p=0.001) and feeding frequency with underweight status (χ²= 8.67, p = 0.003). Children of caregivers with high nutrition knowledge had higher mid upper arm circumference (MUAC) scores (13.5 cm vs. 12.2 cm; t=4.78, p<0.001). Mediation analysis showed caregiver practices reduced the direct effect of food insecurity on nutrition outcomes by around 30%.
Conclusions: Hygiene practices were significantly associated with stunting and feeding frequency with underweight status. Children of caregivers with high nutrition knowledge had significantly higher MUAC scores. Mediation analysis showed that caregiver practices reduced the direct effect of food insecurity on nutrition outcomes by around 30%.