Abstract
The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is designed to measure the independent and combined effects of improved water, sanitation, and hygiene and improved infant feeding on child stunting and anemia in Zimbabwe. We developed and pilot-tested the infant feeding intervention delivered by 9 village health workers to 19 mothers of infants aged 7–12 months. Between September 2010 and January 2011, maternal knowledge was assessed using mixed methods, and infant nutrient intakes were assessed by 24-hour recall. We observed positive shifts in mothers' knowledge. At baseline, 63% of infants met their energy requirement and most did not receive enough folate, zinc, or calcium; none met their iron requirement. Postintervention, all infants received sufficient fat and vitamin A, and most consumed enough daily energy (79%), protein (95%), calcium (89%), zinc (89%), folate (68%), and iron (68%). The SHINE trial infant feeding intervention led to significant short-term improvements in maternal learning and infant nutrient intakes.
Highlights
Childhood undernutrition causes 45% of child deaths [1] and leads to long-term cognitive deficits, fewer years and poorer performance in school, lower adult economic productivity, and a higher risk that one’s children will be undernourished, perpetuating the problem into future generations [2]
Receipt of the draft infant and young child feeding (IYCF) intervention by 19 mothers participating in this pilot evaluation was associated with increased maternal knowledge and evidence of transformational learning
Improvements in infant dietary intake observed in this pilot evaluation in which village health workers (VHWs) delivered modules were similar in magnitude to improvements observed when the counseling interactions were provided by trained district nutritionists in our previous study [6]
Summary
Childhood undernutrition causes 45% of child deaths [1] and leads to long-term cognitive deficits, fewer years and poorer performance in school, lower adult economic productivity, and a higher risk that one’s children will be undernourished, perpetuating the problem into future generations [2]. The goal of the present pilot study was to build on learning from the TIPs to design and pilot an infant and young child feeding (IYCF) intervention for implementation in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. Across all 4 treatment arms, village health workers (VHWs) make 15 visits to SHINE mother–infant dyads when they deliver specified primary healthcare messages Four of these visits focus on promotion of exclusive breastfeeding (EBF); that is, EBF is part of SHINE’s standard of care promoted through all 4 treatment arms. Based on the TIPS findings, we designed an IYCF intervention to focus on increasing nutrient density, increasing dietary diversity, communicating the importance of locally available foods for infant health, and the introduction of SQ-LNS (nutrient composition is included in Table 1 of Supplementary Appendix). We included responsive feeding and the importance of continued breastfeeding and increased feeding during and after illness, as these care practices are often lacking throughout the world and can augment the risk of malnutrition [4]
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