BACKGROUND: The World Health Organisation's Infant and Young Children Feeding Guidelines (IYCF) have been adopted as an internationally acceptable complementary feeding guideline, known as the Minimum Acceptable Diet (MAD). The MAD is the combination of the Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD). MAD is not met in many countries in the world. This study, therefore, aims to investigate the prevalence and multilevel factors associated with a minimum acceptable diet among the children aged 6-23 months in Lesotho. METHODS: The study used the Lesotho Multiple Cluster Indicator Survey of 2018. The data was analysed using STATA version 14 software. A multilevel logistic regression model was fitted. The Wald adjusted odds ratio (WAOR) with P-value <
0.05 was taken to indicate statistical significance. RESULTS: The prevalence of the MAD in Lesotho for the children aged 6-23 months was 10.4% [95% CI: 8.1, 12.3]. At the immediate level, the children aged 12-17 months [WAOR = 2.4
95% CI: 1.5, 4.0] were more likely to be fed the MAD. At the underlying level, the children from rural areas [WAOR = 0.5
95% CI: 0.3, 0.7] were less likely to be fed with the MAD while those from the rich households [WAOR = 2.2
95% CI: 1.2, 4.1] and the richest households [WAOR = 3.4
95% CI: 1.8, 6.4], as well as those with the mothers with secondary education [WAOR = 1.9
95% CI: 1.1, 3.1] and education beyond secondary [WAOR = 4.8
95% CI: 2.4, 9.6] had elevated odds of being fed MAD. Additionally, the children, whose mothers received antenatal care during pregnancy [WAOR = 0.6
95% CI: 0.0, 0.9] and those whose mothers were exposed to media [WAOR = 1.6
95% CI: 1.1, 2.5], were more likely to be fed the MAD. At the community level, the community ownership of land and livestock [WAOR = 0.4
95% CI: 0.3, 0.6], community poverty [WAOR = 0.5
95% CI: 0.3, 0.7], community male education [WAOR = 2.1
95%% CI: 1.4, 3.2] and community media exposure [WAOR = 2.4
95% CI: 1.5, 3.8] were also associated with MAD. CONCLUSION: The findings suggest targeting community food availability and knowledge acquisition. Expanding information availability through radio and other social media would help.