Effect of a Short-Message-Service (SMS) and Inter-Personal Communication (IPC) Strategy on Maternal and Child Nutrition Outcomes: A Factorial Design Cluster Randomized Trial

Abstract

Background: Sub-optimal infant and child feeding and growth faltering persist in Tanzania. We evaluated the effects of delivering nutrition/health messages through short-message-service (SMS) and interpersonal communication (IPC) strategies, separately and in combination, on maternal and child dietary diversity and nutritional status. Methods: This study was a 2×2 factorial, 40-cluster-randomized trial (10 clusters per group) with three intervention groups (SMS, IPC, and SMS+IPC) and a usual care (or ‘control’) among households containing a pregnant woman and/or a child <12 m of age at baseline (600 per group). Results: Data were complete for 2245 woman-child pairs. Compared to the control group, the odds of consuming a diet that met the women’s minimum dietary diversity (MDD) threshold were 1·46 (95%CI: 1·02, 2·09) and 2·03 (95%CI: 1·41, 2·92) times higher in IPC and SMS+IPC groups, respectively. Relative to the control group, the odds of meeting child’s MDD, minimum meal frequency, and minimum acceptable diet, respectively were 1·33 (95%CI: 0·99, 1·80, not significant), 1·77 (95%CI: 1·42, 2·21), and 1·65 (95%CI: 1·35, 2·03) times higher in the IPC and 1·90 (95%CI: 1·49, 2·41), 1·75 (95%CI: 1·38, 2·23), and 2·22 (95%CI: 1·71, 2·90) times higher in the SMS+IPC group. There were significant improvements in maternal nutrition knowledge, relative to the control group, in all intervention groups but no effects on maternal or child anthropometric outcomes. Conclusions: An interactive IPC strategy significantly improved maternal and young child diets. Combining IPC with an SMS component appeared to improve diets slightly more, but SMS alone had no impact. Funding: This research was funded by the Eleanor Crooke Foundation (grant number 66450). Conflict of Interest: None to declare. Ethical Approval: This study was registered on ClinicalTrials.gov (NCT03297190). Ethical approval was obtained from the Medical Research Coordinating Committee of Tanzania’s National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/2684).