Abstract
We designed and tested an intervention that used dialogue-based groups to engage infants' fathers and grandmothers to support optimal infant feeding practices. The study's aim was to test the effectiveness of increased social support by key household influencers on improving mothers' complementary feeding practices. Using a quasi-experimental design, we enrolled mothers, fathers, and grandmothers from households with infants 6-9 months old in 3 rural communities (1 intervention arm with fathers, 1 intervention arm with grandmothers, and 1 comparison arm) in western Kenya. We engaged 79 grandmothers and 85 fathers in separate dialogue groups for 6 months from January to July 2012. They received information on health and nutrition and were encouraged to provide social support to mothers (defined as specific physical actions in the past 2 weeks or material support actions in the past month). We conducted a baseline household survey in December 2011 in the 3 communities and returned to the same households in July 2012 for an endline survey. We used a difference-in-difference (DiD) approach and logistic regression to evaluate the intervention. We surveyed 554 people at baseline (258 mothers, 165 grandmothers, and 131 fathers) and 509 participants at endline. The percentage of mothers who reported receiving 5 or more social support actions (of a possible 12) ranged from 58% to 66% at baseline in the 3 groups. By endline, the percentage had increased by 25.8 percentage points (P=.002) and 32.7 percentage points (P=.001) more in the father and the grandmother intervention group, respectively, than in the comparison group. As the number of social support actions increased in the 3 groups, the likelihood of a mother reporting that she had fed her infant the minimum number of meals in the past 24 hours also increased between baseline and endline (odds ratio [OR], 1.14; confidence interval [CI], 1.00 to 1.30; P=.047). When taking into account the interaction effects of intervention area and increasing social support over time, we found a significant association in the grandmother intervention area on dietary diversity (OR, 1.19; CI, 1.01 to 1.40; P=.04). No significant effects were found on minimum acceptable diet. Engaging fathers and grandmothers of infants to improve their knowledge of optimal infant feeding practices and to encourage provision of social support to mothers could help improve some feeding practices. Future studies should engage all key household influencers in a family-centered approach to practice and support infant feeding recommendations.
Highlights
We focused on the material, financial, and physical support actions that were more likely to be provided by both fathers and grandmothers
The 3 groups differed significantly, for 3 variables: marital status (100% of the mothers in the father intervention area were married compared with 88% in the grandmother intervention area and 79% in the comparison area), mother’s education, and spouse’s education
We found a greater increase between baseline and endline in the percentage of mothers who reported feeding thicker and more diverse foods to their infants in the grandmother intervention area than in the comparison area, and greater improvements in reported feeding of animalsource foods in both the grandmother and father intervention areas
Summary
Is family support as important to young child feeding as an individual mother’s caregiving knowledge alone? Many behavior change approaches focus on improving knowledge gaps of mothers and pay little attention to ecological and social factors that may negatively affect a mother’s infant feeding behaviors.[1]Role of Social Support in Improving Infant Feeding Practices www.ghspjournal.orgYet household members, including fathers and grandmothers, exert social influences—sometimesHousehold members often negative because of cultural norms—on a mother’s adoption of optimal infant feeding practices.[2,3,4,5] exert socialPrograms that include innovative approaches to influences on a engage these key influencers to provide positive mother’s adoption of optimal infant feeding practices.social support could be more successful in changing behaviors to improve maternal and child nutrition than programs that focus only on improving mothers’ knowledge.Malnutrition is a contributing factor in 45% of under-5 child deaths.[6]. Household members often negative because of cultural norms—on a mother’s adoption of optimal infant feeding practices.[2,3,4,5] exert social. Programs that include innovative approaches to influences on a engage these key influencers to provide positive mother’s adoption of optimal infant feeding practices. Optimal infant and young child feeding (IYCF) practices contribute greatly to child nutrition. Such optimal practices include exclusive breastfeeding for 6 months and appropriate complementary feeding from 6 months through at least 2 years of age. Some programs have focused on promoting optimal breastfeeding and have shown success, but there has been less programmatic focus on feeding young children from 6 months of age.[7] Appropriate complementary feeding includes timely initiation of solid/. The study’s aim was to test the effectiveness of increased social support by key household influencers on improving mothers’ complementary feeding practices
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