Infant And Young Child Feeding Counseling Research Articles

Moderate Accuracy of Survey Responses about Infant and Young Child Feeding Counseling Reported by Mothers with Children Less than 1 Year of Age in India

BackgroundCounseling on infant and young child feeding (IYCF) to support optimal breastfeeding and complementary feeding practices is an essential intervention, and accurate coverage data is needed to identify gaps and monitor progress. However, coverage information captured during household surveys has not yet been validated. ObjectivesWe examined the validity of maternal reports of IYCF counseling received during community-based contacts and factors associated with reporting accuracy. MethodsDirect observations of home visits conducted by community workers in 40 villages in Bihar, India served as the “gold standard” to maternal reports of IYCF counseling received during 2-wk follow-up surveys (n = 444 mothers with children less than 1 y of age, interviews matched to direct observations). Individual-level validity was assessed by calculating sensitivity, specificity, and AUC. Population-level bias was measured using the inflation factor (IF). Multivariable regression models were used to examine factors associated with response accuracy. ResultsPrevalence of IYCF counseling during home visits was very high (90.1%). Maternal report of any IYCF counseling received in the past 2 wk was moderate (AUC: 0.60; 95% CI: 0.52, 0.67), and population bias was low (IF = 0.90). However, the recall of specific counseling messages varied. Maternal report of any breastfeeding, exclusive breastfeeding, and dietary diversity messages had moderate validity (AUC > 0.60), but other child feeding messages had low individual validity. Child age, maternal age, maternal education, mental stress, and social desirability were associated with reporting accuracy of multiple indicators. ConclusionsValidity of IYCF counseling coverage was moderate for several key indicators. IYCF counseling is an information-based intervention that may be received from various sources, and it may be challenging to achieve higher reporting accuracy over a longer recall period. We consider the modest validity results as positive and suggest that these coverage indicators may be useful for measuring coverage and tracking progress over time.

Lessons Learned From Integrating Infant and Young Child Feeding Counseling and Iron-Folic Acid Distribution Into Routine Immunization Services in Ethiopia.

Immunization programs reach more children and communities than any other health intervention, thus making immunization a promising platform for integrating other essential health services. There is a dearth of literature on integrating nutrition interventions, such as infant and young child feeding (IYCF) counseling and iron-folic acid (IFA) supplementation, into routine immunization services.To address this evidence gap, a 15-month pilot study (August 2019 to November 2020) tested the feasibility of integrating IYCF counseling and IFA supplement distribution into immunization service delivery in Ethiopia. The interventions focused on joint microplanning for integrated services (including estimating target populations for all services), revising client flows for service delivery, and providing on-the-job support to HWs for implementing and monitoring integrated service delivery.Findings suggest that planning for and delivering IYCF counseling and IFA supplementation with immunization services is feasible. Integrating these services provided opportunities for collaborative planning and enabled health workers (HWs) to offer multiple services to clients through 1 interaction. However, HWs felt that additional human resources were needed to manage integrated services, especially during integrated outreach and mobile service delivery. HWs also reported that communities appreciated accessing 2 services in 1 visit but expressed reservations about the longer wait times.Countries may consider expanding fixed and outreach immunization services to provide integrated service delivery provided that it is feasible, sustainable, of high quality, and incorporates the careful planning, follow-up, and increased human and financial resources needed to reinforce new practices and expand access to a broader array of health services.

Barriers and Facilitators to Optimal Infant and Young Child Feeding Practices in the Central Region of Ghana: Perceptions of Heath Care Providers

ObjectivesThis qualitative study sought to describe provider’s perspectives on barriers and facilitators to optimal infant and young child feeding (IYCF) practices (primarily exclusive breastfeeding (EBF), meal frequency, and diet diversity) among caregivers in Central Region of Ghana. MethodsQualitative data were collected through audiotaped in-depth interviews with care providers from three districts within the Central Region of Ghana: Gomoa East, KEEA, and Assin South (N = 18). Interviews were conducted in English, were audio taped, and transcribed. Transcripts were read and coded independently by two authors, consensus was reached about emerging domains and themes, and a final codebook was developed. The socioecological model was used to map barriers and facilitators for EBF and complementary feeding (CF) practices. ResultsPreliminary findings showed that several barriers and facilitators were similar for EBF and CF within each level. Individual level barriers included returning to work, poor maternal hygiene and ill health, limited maternal IYCF knowledge. Additional EBF barriers included not recognizing early hunger signs, breast problems, perceived breastmilk insufficiency while additional CF barriers were related to food access, time for preparation, and food safety. Interpersonal barriers/facilitators included family/provider support, family cultural beliefs/practices, family influence on practices, provider IYCF knowledge/education delivery, role modeling. Community level barriers/facilitators were related to the built environment including access to health facility and sanitation as well as community-level characteristics such as illiteracy and traditional beliefs. Societal barriers/facilitators included industry advertising, and IYCF policies/guidelines. Poverty was identified as a cross-cutting barrier. Providers recommended intensifying IYCF counseling, home visits to address barriers and training IYCF counseling. ConclusionsProviders were aware of challenges caregivers face when trying to practice optimal IYCF. Multi-level interventions are needed, including IYCF counseling to address identified barriers. Funding SourcesThis study was funded by UNICEF-Ghana.

Validation of Survey Questions on Counseling About Infant and Young Child Feeding Received by Mothers in Bihar, India

ObjectivesScarce data exists on coverage of infant and young child feeding (IYCF) counseling, which includes counseling about breastfeeding and complementary feeding, because few large-scale surveys have included questions to capture the coverage of these essential nutrition interventions. Consequently, maternal report of this information during household surveys has not been validated. We examined the validity of maternal report of IYCF counseling received during home visits and factors associated with response accuracy. MethodsDirect observations of home visits conducted by community workers in 40 villages in Bihar, India, served as the “gold standard” to maternal report of IYCF counseling received during 2-week follow-up surveys (n = 444 mothers with children less than 1 year of age, interviews matched to direct observations). Individual-level validity was assessed by calculating sensitivity, specificity, and area under ROC curve (AUC). Population-level bias was measured using the inflation factor (IF). Multivariable regression models were used to examine factors associated with response accuracy. ResultsActual prevalence of IYCF counseling during home visits was very high (90.1%). Maternal report of any IYCF counseling received in the past 2 weeks had moderate validity (AUC = 0.60, 95% CI: 0.52, 0.67), and population bias was low (IF = 0.90). However, recall of specific counseling messages varied. Maternal report of any breastfeeding, exclusive breastfeeding, and dietary diversity messages had moderate validity (AUC > 0.60), but other child feeding messages had low individual validity. Maternal characteristics associated with response accuracy varied by indicator, but accuracy on reporting of any IYCF counseling received was associated with higher education level and lower mental stress scores. ConclusionsValidity of IYCF counseling coverage varied by indicator but was moderate for several key indicators and performed comparably to other health counseling coverage indicators. Given that counseling is an intervention involving intangible inputs, we consider these modest validity results as positive and suggest that these coverage indicators may be useful for measuring coverage and tracking progress over time. Funding SourcesBill & Melinda Gates Foundation, through IMPROVE-Coverage and DataDENT, managed by Johns Hopkins University.

Integrating a Targeted Breastfeeding Promotion Intervention Into Routine Health Services in Private Health Facilities in Lagos State, Nigeria Is Feasible

ObjectivesThe majority of health providers in Lagos, Nigeria are private, but few of them offer breastfeeding counseling. From May 2019-April 2020, Alive & Thrive implemented a breastfeeding promotion intervention in collaboration with 10 private health facilities in Lagos. The intervention included implementation of the Baby-Friendly Hospital Initiative, training for providers, and provision of breastfeeding counseling to women in person and on Whatsapp, breastfeeding Whatsapp support groups, and infant and young child feeding (IYCF) counseling materials. The objective of our research was to examine the feasibility of integrating the intervention into routine health services using a mixed-methods process evaluation. MethodsWe conducted in-depth interviews (IDIs) with 20 health facility leaders and providers, 90 structured observations and exit interviews with women during the 3rd trimester and at 6 weeks postpartum. The IDIs were transcribed and analyzed thematically in Dedoose software (version 8), and the structured observations and exit interviews were summarized as proportions. ResultsThe IDIs indicated that almost all health facility leaders and providers had positive experiences with the intervention. Facilitators included the training received, support from facility leaders, and availability of IYCF counseling materials. Barriers included increased workloads, paperwork, and health providers’ use of personal time for counseling on Whatsapp. Observations and exit interviews suggested that breastfeeding counseling improved over time. Exit interviews also showed that most mothers were very satisfied with services and were very confident they could carry out the breastfeeding advice they had received. ConclusionsProvision of breastfeeding counseling and support through private health facilities is feasible, but service delivery challenges must be considered for successful scale-up of the intervention in Nigeria. Funding SourcesThis research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation Irish Aid, and other donors.

Counselor’s Knowledge, Attitude and Practice of Infant and Young Child Feeding (IYCF) Counselling

Background: Efforts to reduce the prevalence of undernutrition can be done with the proper IYCF practices. IYCF promotion and counseling activities for caregivers can increase the success of IYCF implementation and reduce the prevalence of malnutrition.Objectives: The objective of this study is to determine the association between the level of education, knowledge, and behavior of Posyandu counselors on IYCF practice in the Parongpong District of West Bandung Regency.Materials and Methods: This research is a cross-sectional study with a consecutive sampling technique. Descriptive analysis was conducted to describe the characteristics of the respondents, and the multivariate test was used to determine the variables meets the model equation.Results: Multivariable analysis showed that the variables that were significantly related to the practice of IYCF counseling were the level of education, knowledge, and behavior which were controlled by the confounding variable for the period of being a counselor.Conclusion: The level of education, knowledge, and behavior of Posyandu counselors in IYCF counseling practice is an important factor that can support the improvement of children's nutritional status.

What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh

BackgroundCommunity health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh.MethodsThis qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach.ResultsResults suggest the removal of financial incentives was perceived to have negatively impacted CHWs’ desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs’ level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities.ConclusionsThis study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases.

A Qualitative Evaluation Study of The Infant and Young Child Feeding Counselling

Introduction: The Infant and young child feeding (IYCF) counselling program is an international strategy to improve IYCF practices in the community. This study aimed to explore the implementation of the program through the logic model approach.Methods: A qualitative method was employed for this evaluation study. Fifteen participants were selected by purposive random sampling, and data collection was conducted by in-depth interview, focus group discussion, observation, and document study. Data were processed from transcription, reduction, coding, categorizing to data interpretation and assessed by content analysis.Results: IYCF training is a cascading training and a combination of adult and fun learning that effectively produces a mixture of counsellors who can provide counselling using the counselling cards. However, the gap in the number of cadre counsellors and the target of counselling, as well as the limited time, low financial support, over workload, and inadequate supervision, resulted in poor recording and low numbers of clients who had been exposed to counselling. Nevertheless, this counselling has a positive effect on maternal knowledge and attitude. Still, the existence of traditional community practices, family and environmental factors are barriers to the implementation of proper IYCF practices.Conclusion: IYCF counselling effectively improved IYCF practices, so it has to be continued with strengthening the number of counsellors, recording and supervision activities. Changing strategy in counselling by involving other adult household members like grandmother or neighbours are explicitly targeted for more effective in improving the practices of infant and young child feeding.

Evaluation of mobile phone-based Positive Deviance/Hearth child undernutrition program in Cambodia.

Child undernutrition in Cambodia is a persistent public health problem requiring low‐cost and scalable solutions. Rising cellphone use in low‐resource settings represents an opportunity to replace in‐person counselling visits with phone calls; however, questions remain on relative effectiveness. Our objective was to evaluate the impact of two options for delivering a World Vision infant and young child feeding (IYCF) counselling programme: (1) traditional Positive Deviance/Hearth (PDH) programme with in‐person visits or (2) PDH with Interactive Voice Calling (PDH‐IVC) which integrates phone calls to replace 62.5% of face‐to‐face interaction between caregivers and volunteers, compared to the standard of care (SOC). We conducted a longitudinal cluster‐randomised controlled trial in 361 children 6–23 months. We used an adjusted difference‐in‐difference approach using baseline, midline (3 months) and endline (12 months) surveys to evaluate the impact on child growth among the three groups. At baseline, nearly a third of children were underweight, and over half were food insecure. At midline the PDH group and the PDH‐IVC groups had improved weight‐for‐age z‐scores (0.13 DID, p = 0.011; 0.13 DID, p = 0.02, respectively) and weight‐for‐height z‐score (0.16 DID, p = 0.038; 0.24 DID, p = 0.002), relative to SOC. There were no differences in child height‐for‐age z‐scores. At endline, the impact was sustained only in the PDH‐IVC group for weight‐for‐age z‐score (0.14 DID, p = 0.049), and the prevalence of underweight declined by 12.8 percentage points (p = 0.036), relative to SOC. Integration of phone‐based IYCF counselling is a potentially promising solution to reduce the burden of in‐person visits; however, the modest improvements suggest the need to combine it with other strategies to improve child nutrition.

Determination of the impact of infant and young child feeding counselling services on the knowledge of mother-children dyads less than two years

Background: Optimum infant and young child feeding (IYCF) practices are essential for adequate growth and development of infants and children. Malnutrition in children occurs almost entirely during the first two years of life, is virtually irreversible after that. Despite the IYCF guidelines, there is no consistent literature on the prevalence of existing IYCF practices and impact of optimum IYCF practices. This study was conducted to estimate the prevalence of existing IYCF practices and to determine the impact of IYCF counseling in children less than 2 years.Methods: A cross-sectional before and after study was done in mother-children dyads (aged 0-24 months). All 125 mother-children dyads were interviewed using prevalidated IYCF questionnaire after obtaining informed consent. The pre-counseling knowledge of mothers, on existing IYCF practices were analyzed using IYCF core and optional indicators. At 6 weeks, the post-counselling knowledge of the mothers was assessed using the same core and optional indicators.Results: Exclusive breastfeeding was seen in 18 of 43 (41.8%) mothers who showed statistically significant improvement to 40 (93%) (p<0.001) after counseling. Children ever breastfed were 62.4%. Predominat breastfeeding was observed in 24%. Initiation of complementary feeding at 6 months of age, improved significantly (p<0.001) post-counseling from 19 mothers (82.6%) to 23 mothers (100%). Minimum dietary diversity improved significantly post counseling, from 23 (28.7%) children to 70 children (87.5%) (p=0.03). Minimum meal frequency was only 22 (48.8%) in breastfed and 8 (22.9%) in non-breastfed children before counseling and improved to 40 (88.9%) in breastfed and 28 (80%) in non-breastfed children (p=0.04). The minimum acceptable diet was given to 2 (4.4%) children aged 6-23 months out of 45 in the breastfed group and on counseling, it improved to 37 (82.23%), which was statistically significant (p<0.001). Among the 35 non-breastfed children, with 2 children aged 6-23 months receiving minimally acceptable diet increased to 28 (80%) post counseling, which was found to be statistically significant (p<0.0001). A significant reduction in bottle feeding was observed from 52 (41.6%) mothers bottle feeding pre counseling, to 18 (1.4%) post counseling (p<0.001).Conclusions: The present study concludes that maternal education on IYCF practices improves their knowledge significantly irrespective of their socioeconomic and education status. Effective IYCF counselling services improve the growth and development of a child. IYCF counselling services provide a critical window of opportunity to tackle the malnutrition crisis and ensure and promote appropriate child growth and survival.

Home Fortification of Complementary Foods Reduces Anemia and Diarrhea among Children Aged 6-18 Months in Bihar, India: A Large-Scale Effectiveness Trial.

ABSTRACTBackgroundHome fortification of complementary foods with multiple micronutrient powders (MNPs) is recommended to reduce child anemia in resource-poor settings. However, evidence of program effectiveness in India to guide policies and programs is lacking.ObjectivesWe implemented a large-scale intervention of MNPs in Bihar, India. The primary outcome was MNP consumption and change in hemoglobin concentration among children aged 6–18 mo between baseline and endline (12 mo). Secondary outcomes were change in child weight and length and infant and young child feeding (IYCF) practices (initiation, diversity, and feeding frequency). Ad hoc analyses included changes in anemia; stunting; underweight; wasting; and reported diarrhea, fever, and hospitalization.MethodsWe conducted a cluster-randomized, effectiveness trial in >4000 children within the context of ongoing health and nutrition programs implemented by CARE, India. Seventy health subcenters were randomly assigned to receive either MNPs with IYCF counseling (intervention) or IYCF counseling only (control). We used an adjusted difference-in-difference approach using repeat cross-sectional surveys at baseline and endline to evaluate impact.ResultsAt baseline, 75% of intervention and 69% of control children were anemic and 33% were stunted. By endline, 70% of intervention households reported their child had ever consumed MNPs, and of those, 64% had consumed MNPs in the past month. Relative to control, hemoglobin concentration increased (0.22 g/dL; 95% CI: 0.00, 0.44 g/dL) and anemia declined by 7.1 percentage points (pp) (95% CI: –13.5, –0.7 pp). There was no impact on anthropometry nor IYCF practices. However, there was a decline of 8.0 pp (95% CI: –14.9, –1.1 pp) in stunting among children aged 12–18 mo. Diarrhea prevalence in the past 2 wk was reduced by 4.0 pp (95% CI: –7.6, –0.4 pp).ConclusionsHome fortification of complementary foods within a government-run program in Bihar had moderate compliance and caused modest improvements in hemoglobin and reductions in anemia and diarrhea prevalence.

The Implementation of Infant and Young Children Feeding Counseling

BACKGROUND: Counseling is an important part of successful infant and young child feeding (IYCF). Optimal IYCF is a key area for improving child survival and promoting healthy growth and development. AIM: The purpose of this study is to determine the characteristics and to provide an overview of the input, process, and output components of IYCF counseling in the Central Sulawesi stunting area. MATERIALS AND METHODS: This type of research is a semi-quantitative study which describes the knowledge and abilities of counselors. The population in this study were nutrition officers, midwives, and cadres who had received IYCF training and had followed the orientation of the IYCF module for at least 30 h in stunting focus locations. The sample in the study was counselors who received training in three subdistricts of Central of Sulawesi. RESULTS: The informants were 14 IYCF counselors. All respondents were female, aged 22–48 years. The method of counseling is by the counselor visiting pregnant women/mothers of toddlers/caregivers directly and face to face. In general, inadequate counseling room facilities are the barrier faced by counselors. Training was only limited to orientation and there was no post-training monitoring. The activities carried out by the counselor are in the range of 70–86%. Benefit of giving counseling for IYCF is that mothers will know nutritional status of their children. IYCF increases knowledge about breastfeeding better than milk formulas, the right type and age of feeding. The training has referred to the module referring to the WHO/UNICEF module which is presented in 37 h of field lessons. CONCLUSIONS: Counseling is an important part of successful IYCF. The method of counseling is by the counselor visiting pregnant women/mothers of toddlers/caregivers directly and face to face. Benefit of giving counseling for IYCF is that mothers will know nutritional status of their children.

An Integrated Enhanced Infant and Young Child Feeding (IYCF) and Micronutrient Powder Intervention Improved Select IYCF Practices Among Caregivers of Children Aged 12-23 Months in Eastern Uganda.

There is little evidence of the impact of integrated programs distributing nutrition supplements with behavior change on infant and young child feeding (IYCF) practices. We evaluated the impact of an integrated IYCF/micronutrient powder intervention on IYCF practices among caregivers of children aged 12-23mo in eastern Uganda. We used pre-post data from 2 population-based, cross-sectional surveys representative of children aged 12-23 mo in Amuria (intervention) and Soroti (nonintervention) districts (n=2816). Caregivers were interviewed in June/July at baseline in 2015 and 12 mo after implementation in 2016. We used generalized linear mixed models with cluster as a random effect to calculate the average intervention effect on receiving IYCF counseling, ever breastfed, current breastfeeding, bottle feeding, introducing complementary feeding at age 6 mo, continued breastfeeding at ages 1 and 2 y, minimum meal frequency (MMF), minimum dietary diversity, minimum acceptable diet (MAD), and consumption of food groups the day preceding the survey. Controlling for child age and sex, household wealth and food security, and caregiver schooling, the intervention was positively associated with having received IYCF counseling by village health team [adjusted prevalence difference-in-difference (APDiD): +51.6%; 95% CI: 44.0%, 59.2%]; timely introduction of complementary feeding (APDiD: +21.7%; 95% CI: 13.4%, 30.1%); having consumed organs or meats (APDiD: +9.0%; 95% CI: 1.4%, 16.6%) or vitamin A-rich fruits or vegetables (APDiD: +17.5%; 95% CI: 4.5%, 30.5%); and MMF (APDiD: +18.6%; 95% CI: 11.2%, 25.9%). The intervention was negatively associated with having consumed grains, roots, or tubers (APDiD: -4.4%; 95% CI: -7.0%, -1.7%) and legumes, nuts, or seeds (APDiD: -15.6%; 95% CI: -26.2%, -5.0%). Prevalences of some IYCF practices were low in Amuria at endline including MAD (19.1%; 95% CI :16.3%, 21.9%). The intervention had a positive impact on several IYCF practices; however, endline prevalence of some indicators suggests a continued need to improve complementary feeding practices.

Development and Testing of Responsive Feeding Counseling Cards to Strengthen the UNICEF Infant and Young Child Feeding Counseling Package.

BackgroundThe UNICEF Community-based Infant and Young Child Feeding Counseling Package (C-IYCFCP) currently has limited responsive feeding (RF) content, thus limiting dissemination of RF messages within infant and young child feeding (IYCF) counseling.ObjectivesThis project 1) developed counseling cards based on existing evidence-based RF guidelines and 2) tested their feasibility in Ghana.MethodsFive RF counseling cards were developed focusing on eating with family; introducing new foods; hunger/satiety cues; food texture; and calming a child. Four focus group discussions (FGDs) were conducted with adult mothers and fathers of children younger than 3 y of age to assess the cultural appropriateness of the cards and accompanying key messages. The feasibility of including cards as part of IYCF counseling was tested via 1) systematic observation of 8 group education sessions utilizing the cards with the same target audience and 2) in-depth interviews with health care providers involved in IYCF training and/or counseling.ResultsFGD findings guided changes to all cards to ensure comprehension and cultural appropriateness. The group education sessions suggested that the counseling cards provided important RF messages that are specific, clear, and feasible to implement. Health care providers strongly endorsed the need for and utility of the RF counseling cards and felt they were feasible and important to integrate into the C-IYCFCP currently being used to deliver IYCF training and counseling in Ghana.ConclusionsThe counseling cards have a strong potential to add key RF dimensions to IYCF training and counseling in Ghana.

Community-Based Nutrition Education Improves Caregivers’ Knowledge of Complementary Feeding in Southern Ethiopia

Abstract Objectives Quality Diets for Better Health (QDBH) is a nutrition-sensitive agriculture project in southern Ethiopia that promotes vitamin A-rich orange-fleshed sweetpotato (OFSP) and community-based nutrition education to improve the quality of young child diets. The objective of this research is to examine the impact of the project and other predictors on caregiver knowledge of infant and young child feeding (IYCF) over time. Methods Communities were randomized to a control group and intervention groups receiving OFSP planting materials and community-based nutrition education. Households with infants <6 months completed a baseline survey in January 2018, and follow-up surveys 7 and 13 months later. Knowledge of IYCF recommendations and vitamin A was assessed at each visit; a knowledge score (range 0–100) was calculated by assigning points for accurate responses. If a caregiver was missing not more than two responses, we imputed her score with the community-mean to retain sample size and minimize bias. We used mixed effects modeling to examine the effect of QDBH and other factors, such as education and prenatal counseling, on knowledge scores over time, while controlling for covariates. Results Of the 605 households who completed the baseline survey, 548 (90.6%) and 523 (86.4%) completed the follow-up surveys. Baseline characteristics of the group lost to follow-up did not differ from those retained in the sample. Knowledge scores were highest at baseline (65.3 ± 14.4), and lower at 7 months (48.4 ± 13.8) and 13 months follow-up (46.9 ± 14.0). Baseline scores were higher among caregivers with higher education (P < 0.05) and who reported receiving prenatal IYCF counseling (P < 0.0001), but also declined faster among those who had prenatal counseling (β = −1.6, P = 0.04). Knowledge scores in intervention and control groups were similar at baseline (P = 0.49), but scores of those in the intervention group declined less rapidly than those in the control group (β = 4.0, P < 0.0001). Conclusions Caregivers’ knowledge of IYCF decreased in the postnatal period; decreases were fastest among those who received prenatal IYCF counseling and among those in the control group. Postnatal community-based nutrition education can help maintain knowledge of IYCF recommendations. Funding Sources This research is funded by the European Union in partnership with the International Potato Center.

Measuring coverage of infant and young child feeding counselling interventions: A framework and empirical considerations for survey question design.

Most countries implement nutrition counselling interventions as part of programmes to support breastfeeding and complementary feeding. However, data to track coverage of counselling interventions are rarely available. As a result, little is known about the coverage of counselling on infant and young child feeding (IYCF). Survey‐based data collection systems generally collect data on IYCF practices but do not collect data on coverage of interventions to support IYCF, and those surveys that do collect this information do not do so consistently. We present a framework to guide the design of survey questions to measure IYCF counselling coverage. We provide examples of how large‐scale surveys for programme evaluation and national monitoring have included survey questions to address these data gaps. Our review suggests that elements relevant to designing survey questions to capture coverage of counselling interventions include timing of contact, target behaviour and message content, place of contact, type of service provider, frequency of contact and mode of intervention. Application of this framework may help strengthen harmonized measurement of IYCF counselling coverage to enable better tracking of programme investments, document progress in scaling up nutrition services and allow for cross‐country comparisons. Thus, improving measurement of counselling coverage may lead to improved reach of programmes to support optimal IYCF practices.

Counselling skills of Accredited Social Health Activists for promotion of optimal Infant and Young Child Feeding practices

Background: Accredited Social Health Activists (ASHAs) play an important role in communicating messages related to infant and young child feeding (IYCF) practices. Adequate knowledge and counselling skills are crucial for effective behavior change among mothers. Objective: To assess counselling skills of ASHAs for promotion of optimal IYCF practices among mothers of young children. Material & Methods: ASHAs (n=190) were selected randomly from 21 primary health centres in Delhi. Their knowledge and counselling skills for promotion of optimal IYCF practices were assessed using a questionnaire and simulated counselling sessions based on WHO IYCF counselling course (2006) and IYCF guidelines by WHO (2009), GOI (2006) and IAP (2016). Results: Mean scores of ASHAs on optimal IYCF knowledge and counselling skills were 65.2±11.8% (n=190) and 41.8±9.4% (n=182) respectively. Less than half (45%) of the appropriate key messages were correctly communicated by ASHAs during the simulated counselling sessions. Majority of ASHAs (>75%) used helpful non-verbal communication, simple language and tried solving problems while counselling. Inability to empathise with caregivers, praising good practices and assessing their understanding were the communication skills which most ASHAs (>95%) lacked. Conclusion: There is need to focus on improving their counselling skills for effective promotion of optimal IYCF practices.

Does health worker performance affect clients\u2019 health behaviors? A multilevel analysis from Bangladesh

BackgroundSuboptimal healthcare quality may be a barrier to achieving child health improvements, yet little is known about the relationship between provider compliance with evidence-based practices and client behavior change. We assess provider compliance in the context of infant and young child feeding (IYCF) counseling, its relationship with client IYCF behaviors in Bangladesh, and explore its potential determinants.MethodsWe use data from a 2017 evaluation of an IYCF program that includes a health worker survey (n = 74), caregiver survey (n = 232), and direct service observation checklists of counseling sessions (n = 232 observations of 74 health workers). We assess the relationship between provider compliance with recommended IYCF counseling topics and behaviors (standardized to a 100-point scale) and three reported IYCF behaviors among clients using multi-level models with random effects at the health worker and sub-district (sampling) levels. We also evaluate whether health worker self-efficacy, satisfaction, and technical knowledge are associated with provider compliance.ResultsHealth worker compliance was significantly associated with reported exclusive breastfeeding for children under 6 months of age (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.06, 95% CI 1.01, 1.12) and marginally associated with minimum dietary diversity (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.05, 95% CI 1.00, 1.11). Counseling compliance was significantly and positively associated with both health worker self-efficacy and technical knowledge.ConclusionsWe find evidence for an association between health worker compliance and client health behaviors; however, small effect sizes suggest that behavior change is multifactorial and affected by factors beyond care quality. Improvements to technical quality of care may contribute to desired health outcomes; but policies and programs seeking to change health behaviors through counseling may also wish to target upstream factors such as self-efficacy, alongside technical skill-building and knowledge, for maximum impact.

Development and Testing of Responsive Feeding Counseling Cards in Ghana (OR03-07-19)

Abstract Objectives The United Nations Children Fund (UNICEF) Community based Infant and Young Child Feeding (IYCF) counselling package currently lacks comprehensive responsive feeding curriculum, thus limiting dissemination of these messages within IYCF counselling. Thus, project objectives were to: a) develop counselling cards based on recent evidence-based responsive feeding guidelines and b) test their feasibility in Ghana. Methods Five counselling cards were developed addressing the responsive feeding topics of: enjoying eating with family; hunger/satiety cues; introducing new foods; food texture as a function of child development; soothing a child. The UNICEF image bank was used to develop counselling cards with images compatible with the UNICEF Community based IYCF counselling package. Two peri-urban focus groups (FG) were conducted with Ghanaian mothers (N = 7) and fathers (N = 6) of children < 3 years to assess the cultural appropriateness of the cards. Card revisions were made and re-tested in two rural FGs with the same target audience (N = 10 mothers; N = 4 fathers). Feasibility of including the cards as part of IYCF counselling was tested via: a) in-depth interviews with health care providers providing IYCF training and/or education (N = 14) and b) systematically observing eight educational sessions utilizing the cards with Ghanaian mothers (N = 20) and fathers (N = 18) of children < 3 years. Results FG findings led to changes to card images for each topic to ensure they were culturally and health literacy appropriate. Educational session findings strongly suggest the counselling cards provide important responsive feeding messages that are specific, clear, and feasible for mothers and fathers of children < 3 years to implement. Health care providers strongly endorsed the need for and utility of the responsive feeding counselling cards. Furthermore, they felt the cards and corresponding messages were feasible and important to integrate into the UNICEF Community based IYCF counselling package currently being used to deliver IYCF training and education in Ghana. Conclusions The counselling cards developed and tested have a strong potential to add the key responsive feeding dimension to IYCF training, education, and counselling in Ghana on a large scale. Funding Sources Yale Global Health Leadership Institute.

Comparative Study of Growth Monitoring & Promotion of Children with Special Care (IYCF Counseling) and without Special Care

This comparative study was conducted to see the challenges and impact of counselling of Infant and Young Child Feeding (IYCF) to the mother’s knowledge and the practices of the mother from case group and control on best IYCF interventions, mainly targeted the behavioral change of the mother and to see the effect on the nutritional status of the children under 2 years. A total of 353; 177 mother of case group for counselling and 176 of control group for non-counselling, eligible mothers having children 0-11 months were approached with the purpose of study and informed consent was obtained from the mothers. Then all 177 mothers from case group received IYCF counseling according to the need of mothers as well as on key IYCF messages. At the same time the 176 mothers from control group didn’t receive any kind of IYCF support and counselling, they received only regular health services counselling and messages on IYCF. IYCF practices have a great impact on the physical and mental development of the child. The objective of this study was the lactating mothers with the children in the age group 0-11 months were studied and delivered IYCF counseling according to their need basis as well as key IYCF messages from case group and at the same time mothers from control group would not receive any kind of message from study and they would receive only regular health program messaging. Low percentage of mothers from the case group had knowledge on early initiation of breast feeding within one hour after birth, the exclusive breast-feeding up to 6 months. Timely initiation of complementary feeding after 6 months (61,0%, 58.7%, 61.6% & 55.4% respectively) before IYCF counselling to mothers. After IYCF counselling to the mothers of case group, they motivated and learnt to early initiation of breast feeding within one hour after birth, the exclusive breast-feeding up to 6 months. Timely initiation of complementary feeding after 6 months (79.1%, 75.7%, 75.2% & 65.5% respectively). For control group the results were 61.9%, 65.3%, 65.9% & 63.6% respectively before study and 66.5%, 67.7%, 66.8% & 64.1% after the study. The study result showed that the impact of IYCF counselling and messaging on the mother knowledge was great and it changed the knowledge level of the mother in dramatic way. The percentage of mothers from the case group & the control group those had children over 6 months practiced the exclusive breast-feeding were (60.2% & 73.5%) before study. After IYCF counselling to the mothers of case group, they motivated and changed their attitude to ensure the exclusive breast feeding for their children (73.5% and 73.9% from case and control group respectively). Before the study Minimum Dietary Diversity (MDD) was observed in only 30.3% & 36.6% respectively from case and control group for the children between 6- and 11months age group and after IYCF counselling mothers from the case group improved their practice for MDD for their children aged 6-23 months and increased to 39.0% in case group and in control group improved to 37.3%. Minimum Meal Frequency (MMF) was observed in the majority (63.6%) of children aged 6–23 months before the study and after IYCF intervention it increased to 74.6% in case group. But in Control group it changed from 72.6% to 73.1%. The indirect effect of IYCF counselling on the nutritional status of the children who are benefited from the improved mother knowledge and practices to good practices. Before the controlled comparative study, the GAM rate of the children was 21.1% & 20.3% respectively for case & control group of wasting (WHZ) and after study it was 20.1% & 20.3% respectively for case & control group. The same happened for underweight (WAZ) & stunting (HAZ). They also changed from 36.9% to 35.4% and 45.4% to 43.8% for underweight & stunting respectively. The IYCF practices are strongly influenced by what people know, think and believe and also affected by social circumstances and economic factors. Effective communication for behavioral change is necessary for ensuring optimal infant and young child feeding. Awareness regarding IYCF practices and their benefits in Maternal and Child Health (MCH) is poor leading to poor compliance. It is important to educate mothers during the antenatal visits. This study showed same impact as stated above.