Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia

Sunny S Kim,Phuong Hong Nguyen,Yisehac Yohannes,Yewelsew Abebe,Manisha Tharaney,Elizabeth Drummond,Edward A Frongillo,Marie T Ruel,Purnima Menon

doi:10.1093/jn/nxz087

Abstract

ABSTRACTBackgroundAppropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM).ObjectivesThe aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes.MethodsWe used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6–23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose–response and path analyses to document plausibility of impacts.ResultsAt endline, exposure to IPC was 17.8–32.3%, exposure to AG was 22.7–36.0%, exposure to CM was 18.6–54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose–response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ.ConclusionsDelivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

Highlights

Ethiopia has made considerable progress in reducing infant, child, and maternal mortality during the past decade by expanding primary health care services and improving the quality of health service provision [1]
health extension workers (HEWs) provided infant and young child feeding (IYCF)-focused counseling during health post visits and home visits and conducted food demonstrations, health development team leaders (HDTLs) provided IYCF-focused messaging during home visits, and agricultural extension workers promoted AG activities such as designating a chicken whose eggs are prioritized for a child
Impact on IYCF practices Among all core WHO complementary feeding (CF) indicators (Supplemental Table 1), levels of minimum dietary diversity and minimum acceptable diet improved significantly over time (P < 0.001) in both intensive and nonintensive groups, but the increases were marginally higher in the intensive group (P = 0.08 and P = 0.07, respectively) (Figure 2)

Summary

Introduction

Ethiopia has made considerable progress in reducing infant, child, and maternal mortality during the past decade by expanding primary health care services and improving the quality of health service provision [1]. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Conclusions: Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

Objectives

Methods

Results

Conclusion