Abstract
Background: Low dietary quality and quantity and inappropriate feeding practices can cause undernutrition. Poor nutritional status in early childhood is associated with growth faltering. The objective of the study was to assess the potential of community-based nutrition education to improve height-for-age z-scores in children 6–23 months of age.Methods and Findings: We carried out a cluster-randomized-controlled trial to assess the effectiveness of nutrition education. A total of 24 Extension Planning Area Sections served as clusters. The selection criteria were: the position of the extension officer was staffed and the sections had been selected by the project for activities in its first project year. The sections were randomized into intervention and control restricted on mean height for age Z-score using baseline information. In the intervention area, food security activities and community-based nutrition education was implemented. The control area received food security activities only. At baseline (2011) and endline (2014), caregivers with a child below two years of age were enrolled. Data assessment included anthropometric measurements, interviews on socio-economic status, dietary intake and feeding practices. A difference-in-differences estimator was used to calculate intervention effects. A positive impact on child dietary diversity was observed (B (SE) = 0.39 (0.15), p = 0.01; 95%CI 0.09–0.68). There was a non-significant positive intervention effect on mean height-for-age z-scores (B (SE) = 0.17 (0.12), p = 0.15; 95%CI -0.06–0.41). Limitations: The 24h dietary recalls used to measure dietary diversity did not consider quantities of consumed foods. Unrecorded poor quality of consumed foods might have masked a potential benefit of increased child dietary diversity on growth.Conclusions: Participatory community-based nutrition education for caregivers improved child dietary diversity even in a food insecure area. Nutrition education should be part of programs in food insecure settings aiming at ameliorating food insecurity among communities.
Highlights
Chronic malnutrition, reflected in stunting, is still a major problem among young children in Malawi [1,2,3]
Nutrition education should be part of programs in food insecure settings aiming at ameliorating food insecurity among communities
This study examined the potential impact of a community based nutrition education (NE) on growth of children 6–23 months of age via increased dietary diversity (DD)
Summary
Chronic malnutrition, reflected in stunting, is still a major problem among young children in Malawi [1,2,3]. Inadequate nutrition during early childhood is among the main contributing factors for stunting [4]. Further risk factors for impaired growth development are inappropriate breastfeeding as well as complementary feeding practices in children under two years of age [5,6]. To meet basic nutritional needs, the World Health Organization (WHO) recommends a consumption of at least a minimum of four out of seven different food groups per day for children 6–23 months of age, measured as minimum dietary diversity (MDD) [9]. Besides inadequate DD, poor hygiene, and unhealthy practices, as well as insufficient knowledge of how to optimize DD using available resources for complementary feeding, contribute to high levels of child malnutrition [10,11]. The objective of the study was to assess the potential of community-based nutrition education to improve height-for-age z-scores in children 6–23 months of age
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