Abstract
BackgroundCost-effective approaches to improve feeding practices and to reduce undernutrition are needed in low-income countries. Strategies such as nutritional counseling, food supplements, and cash transfers can substantially reduce undernutrition among food-insecure populations. Lipid-based nutrient supplements (LNS) are an increasingly popular strategy for treating and preventing undernutrition and are often delivered with nutrition education. The post-program effects of participation in a LNS-supported supplemental feeding program on Infant and Young Child Feeding (IYCF) practices and caregiver child feeding knowledge are not well understood. The objective of this study was to understand whether children’s diet quality and caregiver nutrition knowledge was improved after participation in such a program.MethodsWe conducted a post-program comparison group study to compare feeding practices and caregiver nutrition knowledge among mother-child dyads who completed a nutrition education program and a community comparison group in western Uganda. We administered a feeding practices survey and two 24-h dietary recalls to 61 Post-Program (PP) caregivers and children ages 6 to 59 months (mean age = 25.1 months) who participated in a supplemental feeding program (which included growth monitoring, caregiver nutrition education, and LNS) and a Comparison Group (CG) of 61 children and caregivers. PP caregivers were recruited 4 to 8 weeks after program participation ended. We hypothesized that PP caregivers would report better IYCF practices and greater knowledge of key nutrition education messages related to IYCF.ResultsPP children had higher dietary diversity scores (3.0 vs 2.1, p =0.001) than CG children, and were more fed more frequently (3.0 vs 2.1 times per day, p = 0.001). IYCF indicators were higher in the PP group for minimum meal frequency (44.8% vs. 37.9%), minimum dietary diversity (10.3 vs. 3.4%), iron-rich complementary foods (17.2 vs. 20.7%), and minimally acceptable diet (10.3% vs 3.6%), but differences were non-significant. Caregivers in the PP group demonstrated greater knowledge of healthful IYCF practices.ConclusionsNutrition education can be effective to improve caregiver feeding practices and children’s dietary diversity and the frequency by which they are fed. A 10-week nutrition education and supplemental feeding program appears to provide some benefit to children in terms of dietary diversity and frequency of meals, and caregiver knowledge of feeding 1 to 2 months after program completion. However, children in this rural Ugandan region have diets that are still largely inadequate, highlighting the need for enhanced interventions and policies to promote diverse and appropriate diets for young children in this region. Future follow-up work in LNS-supported programs is recommended to understand how other similar approaches influence children's diet quality after program completion in other contexts.
Highlights
Cost-effective approaches to improve feeding practices and to reduce undernutrition are needed in low-income countries
A 10-week nutrition education and supplemental feeding program appears to provide some benefit to children in terms of dietary diversity and frequency of meals, and caregiver knowledge of feeding 1 to 2 months after program completion
Caregivers in Uganda who participated in a 10-week supplemental feeding and nutrition education program fed their children higher quality diets, and reported more comprehensive knowledge of healthful Infant and Young Child Feeding (IYCF) practices than those with no such program exposure
Summary
Cost-effective approaches to improve feeding practices and to reduce undernutrition are needed in low-income countries. Reductions in undernutrition among infants and young children can be made through programmatic health and nutrition interventions [4] Strategies such as nutritional counseling, food supplements, and cash transfers, delivered separately or in combination, aim to improve dietary outcomes and reduce undernutrition among food-insecure populations, with mixed results [5, 6]. Lipid-based nutrient (LNS) supplements can be an effective strategy for improving children’s dietary adequacy and growth and are sometimes delivered as part of holistic supplemental feeding programs that deliver nutrition education along with other intervention such as growth monitoring, deworming, and education on sanitation and hygiene [7, 8]. These holistic programs provide short to medium-term food supplementation, seeking to correct or prevent nutrient deficiencies, with the ultimate of aim of preventing long-term undernutrition through improving dietary patterns
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