Effect on Child Nutrition of Maternal Counselling Delivered by Community Health Workers: A Cluster Randomised Controlled Trial in Karnataka, India

Abstract

Background: India suffers a double burden of undernutrition and anaemia. The Karnataka anaemia project indicated that a counselling intervention delivered by community health workers improved anaemia cure. Objective: To evaluate the effect of maternal counselling on overall child nutrition. Methods: Secondary analysis of a cluster randomised controlled trial (55 villages). Mothers in the intervention group received five monthly counselling sessions plus usual care (iron and folic acid supplements), while the control group received usual care only. The study included 1144 children (1-5 years old), of whom 534 were anaemic. 24-hour dietary recall and questionnaires were used to determine children’s dietary intake (primary outcome), maternal knowledge on nutritional aspects of anaemia (secondary outcome). Follow up was conducted at six months. Linear mixed regression models were used to assess between groups differences. Findings: Daily intake of all nutrients, except vitamin C, increased in both groups from baseline to follow up. The increase was higher among children in the intervention group compared to the control group for all nutrients except vitamin B12. Iron and vitamin C intake increased by 0·24 (95%CI -0·67; 1·15) mg/day and 4.61 (95% CI -0·69; 9·91) mg/day in the intervention group compared to the control group, respectively. Furthermore, children of mothers with low education also benefited from the intervention. Interpretation: The intervention resulted in modest improvements in child nutrition, however comparable between maternal education levels. Previously observed enhancement of anaemia cure rate was probably due to improved adherence to iron and folic acid supplements. Trial Registration: ISRCTN identifier: ISRCTN68413407. Funding: Wellcome Trust/DBT India Alliance. Conflict of Interest: Dr. Shet received a grant from the Wellcome Trust/DBT India Alliance while the study was conducted. No other disclosures are reported. Ethical Approval: The study was approved by the St. Johns National Academy of Health Sciences Institutional Ethical Committee (IEC 115/2012). Mothers and caregivers provided written informed consent to participate. An independent committee was employed to act as data safety and management board. This committee conducted an interim analysis looking at the side effects of IFA supplements. The reported side effects were minor.