Young Child Feeding Counseling Research Articles

Promoting responsive care and early learning practices among caregivers of children 0-23 months in the Kyrgyz Republic: findings from integrating a counselling intervention with nutrition services.

To assess changes in caregiver practices for young children after integrating the Responsive Care and Early Learning (RCEL) Addendum package into nutrition services after 10 months of implementation. We measured changes in RCEL practices through a pre- and post-intervention assessment comprising a household survey and observations. To implement the intervention, we trained health service staff and community volunteers to deliver RCEL counselling to caregivers of children 0-23 months of age through existing community and facility-level platforms. Jalal-Abad and Batken regions in the Kyrgyz Republic. Caregivers of children aged 0-23 months at baseline. We found statistically significant increases in RCEL practices, availability of early learning opportunities in the home, decreases in parenting stress and improvements in complementary feeding practices after the intervention implementation period. Findings show that delivery of RCEL counselling using the RCEL Addendum was associated with improved responsive care practices and early learning opportunities. We also found that integration of RCEL with infant and young child feeding counselling did not disrupt nutrition service delivery or negatively affect complementary feeding outcomes, but rather suggest synergistic benefits. Given the importance of providing holistic care to support optimal early childhood development, these findings provide new evidence on how to strengthen the delivery of nurturing care services in the Kyrgyz Republic.

Training and Deployment of Pastors’ Wives as Peer Counselors for a Church-based Support Service to Improve Exclusive Breastfeeding Practice in Nigeria: A Descriptive Review of Feasibility and Effectiveness

Inadequate support services for common breastfeeding problems are major reasons why many nursing mothers quit exclusive breastfeeding practice in Nigeria. The recent exodus of doctors and other health-care workers has made the situation worse. Community-based interventions are urgently needed to avoid a relapse of the marginal increase of the exclusive breastfeeding rate in the country. Therefore, this study reviewed the feasibility and effectiveness of training and deploying pastors’ wives as breastfeeding peer counselors along with leaders of women’s Bible study classes as co-counselors in a church-based support service to boost exclusive breastfeeding practice in the country. Searches were conducted using appropriate keywords in journals and databases such as Google Scholar, Christian Journal of Global Health, and PubMed. Relevant papers were selected and read thoroughly. Ideas, phrases, and clauses that answered the research questions were synthesized into themes. Previous partnerships with the church to provide support for specific health problems such as HIV/AIDS had been fruitful. The adoption of the Community Infant and Young Child Feeding Counseling Package in small priority areas by the government and its development partners yielded positive results. However, partnerships are necessary to make the service available nationwide. The use of existing opportunities such as the network of pastors’ will be an economical and rational form of the volunteer community mobilizers. Community-based breastfeeding peer counseling has effectively increased the initiation and duration of exclusive breastfeeding and provided an opportunity to address other problems related to breastfeeding. However, the allocation of matching grants to local government areas will be necessary to increase nutrition interventions and to motivate peer counselors.

Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia.

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimumdietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%-46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%-77%). Women involved in home gardening significantly increased (73%-93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. TheSURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.

Development of the generic Community Infant and Young Child Feeding Counselling Package.

Infant and young child feeding (IYCF) promotion is a key component in the set of high impact interventions to improve nutrition. The literature provides evidence of the positive impact of IYCF promotion through various platforms, including communities. In 2009, UNICEF and WHO agreed that a global, "generic" IYCF package of resources and tools to plan, implement, and monitor community-based IYCF programmes and to build skills of community-based workers was needed. In 2010, the UNICEF Community Infant and Young Child Feeding Counselling Package was finalized and field tested under a strategic collaboration between UNICEF New York and Nutrition Policy and Practice and the Center for Human Services/University Research Company. The Package includes 11 tools to guide adaptation of the materials, the design, planning, and implementation of IYCF programmes and the training, monitoring, supervision, and mentoring of community workers, using an interactive and experiential adult learning approach. The Package was rolled out from 2011 onwards and by 2017 was implemented in 87 countries. In 2013, UNICEF and the United States Agency for International Development-funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally project started planning the evaluation, and a study site was selected in Nigeria to assess the efficacy and effectiveness of the Package on IYCF practices, knowledge, and worker skills. This article describes the need for and development of the Package, its content and approach to skills building, as well as its current implementation. Finally, it makes the case for the evaluation of the Package, which is covered in the other papers in the Supplement in relation to the Nigeria evaluation.

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.

Determinants of early interruption of exclusive breastfeeding at Dollo Ado refugee camps, Dollo Ado district, Ethiopia.

nearly three-quarters of infants younger than six months were not exclusively breastfed globally. Despite some research indicating what factors influence early exclusive breastfeeding interruption in Ethiopia's stable population, there is little evidence indicating what factors influence exclusive breastfeeding interruption in vulnerable populations such as refugee camps. Therefore, this study aimed to determine the factors that contributed to the early termination of exclusive breastfeeding in Ethiopian refugee camps in the Dollo Ado district. a case-control study was conducted at the Dollo Ado refugee camps from April 05th to 25th, 2017. The eligible 112 cases and 224 controls were identified using the 24-hour recall method. The information was gathered using an interviewer-administered questionnaire that was pretested and organized. Logistic regression analysis was computed to assess the effect of independent variables. the determinants for early interruption of exclusive breastfeeding were not counseled about infant feeding during antenatal care follow-up (adjusted odds ratio (AOR =5.87, 95% CI [2.61-13.1]), not counseled about infant feeding during postnatal care service use (AOR= 4.33, 95% CI [2.71-10.8), breastfeeding problem (AOR= 5.62, 95% CI [4.55-15.2]) and late initiation of breastfeeding (AOR= 4.79, 95% CI [28-10.1]). in this study, early termination of exclusive breastfeeding was caused by breastfeeding problems and late commencement of breastfeeding, as well as not receiving infant feeding advice during antenatal care or postnatal care. The results of this study highlight the significance of concentrating on newborn and young child feeding counseling during prenatal and postnatal care services in order to promote exclusive breastfeeding. In addition, health providers should educate parents on the significance of starting exclusive breastfeeding on time and obtaining help right away if there is a problem, such as breast soreness or the infant refusing to eat due to oral trash, to avoid early exclusive breastfeeding interruption.

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.

Strengthening Maternal, Infant, and Young Child Nutrition Training and Counseling in Ghana: A Community-Based Approach

ABSTRACTBackgroundEvidence-based maternal, infant, and young child nutrition (MIYCN) counseling provides caregivers essential nutrition education to optimize infant and young child feeding practices and subsequently improve child growth and development. Effective integration of responsive feeding (RF) into current MIYCN training requires working with priority communities.ObjectivesStudy objectives were to 1) assess MIYCN knowledge and practices among Ghanaian caregivers, 2) identify factors influencing RF/responsive parenting (RP) among Ghanaian caregivers, 3) identify barriers and facilitators influencing MIYCN training and counseling among Ghanaian health care providers, and 4) document recommendations for integrating an RF curriculum into the existing MIYCN training.MethodsThis was a qualitative study, conducted within the Central Region of Ghana, based on 1) 6 focus groups with caregivers of young children (<36 mo; n = 44) and 2) in-depth interviews with health care providers (n = 14). Focus group transcripts were coded independently, consensus was reached, and a final codebook developed. The same coding process and thematic analysis were applied to the in-depth interviews.ResultsCaregivers identified 3 domains influencing the primary outcome of RF/RP knowledge and practices and the secondary outcome of MIYCN: 1) health care provider counseling; 2) support from family, friends, and community members; and 3) food safety knowledge and practice. Providers identified barriers to MIYCN provider training as well as caregiver counseling which included limited access to financial and counseling resources and limited qualified staff to deliver infant and young child feeding counseling. Identified facilitators included availability of funding and counseling staff with adequate resources. Health care providers strongly endorsed integrating an RF curriculum into MIYCN training and counseling along with providing RF training and distribution of RF materials/tools to facilities.ConclusionsHealth care providers directly influenced RF/RP practices through MIYCN counseling. Strengthening MIYCN counseling through the integration of an RF curriculum into MIYCN training is desired by the community.

Implementation Supplementary Feeding Program and Infant and Young Child Feeding Counseling as a Stunting Prevention Program During Pandemic

Large-Scale Social Restrictions (PSBB) as an effort to reduce the transmission of COVID-19 pandemic and COVID-19 pandemic itself hasan impact on stunting prevention program carried out by Public Health Centers (Puskesmas), including the Supplementary Feeding Program (PMT) and Infant and Young Child Feeding Counseling (PMBA) and this condition occurs in various regions in Indonesia, including Bandung. This study aimed to examine the implementation of PMT and PMBA counseling program during the COVID-19 pandemic in the working area of the Buahbatu Public Health Center as one of the public health centers with the highest stunting number in Bandung. This study using the mixed methods concurrent embedded method, in this study quantitative data were used to determine percentage of PMT and PMBA counseling coverage before the COVID-19 pandemic (2017-2019) and during the COVID-19 pandemic (in 2020) as supporting qualitative data done with in-depth interviews. The results showed that the stunting rate increased every year especially during the COVID-19 pandemic, PMT and PMBA counseling continued to be carried out during the COVID-19 Pandemic even though at the beginning of the COVID-19 pandemic the program was hampered, so several adjustments and innovation were made by the public health center officers and cadres to made percentage of stunting children in 2020 is 23,20%, percentage of PMT coverage in 2020 is 100% but percentage for PMBA counseling coverage in 2020 is only 9%. PMT runs smoothly so that all children get PMT, while PMBA counseling runs but is only given to a few stunted children because of some obstacles.

Experience in Growth Monitoring and Promotion Integrated With Immunization Services in a City Corporation of Bangladesh

ObjectivesWe aim to share the experience of the USAID's Strengthening Multi-sectoral Nutrition Programming through Implementation Science Activity (MSNP), which has been integrating Growth Monitoring (GMP) and Expanded Program of Immunization (EPI) for children under two years in Khulna City Corporation (KCC), Ministry of Local Government Rural Development and Cooperatives (LGRD), Bangladesh.MethodsThe team analyzed the GMP and EPI service data, observed client-provider interactions (service delivery) (n = 3 nutrition counselors), conducted semi-structured interview with health assistants (n = 6) and informal discussion with mothers (n = 10) who visited the GMP/EPI service facilities from October 2021 to January 2022.ResultsBoth health assistants and nutrition counselors delivered GMP and EPI services, serving as key enablers of EPI-GMP integration. Reminder text messages were sent by MSNP project to mothers of children lost-for-follow-up to encourage their service return. From October 2021 to January 2022 GMP-EPI integrated services were provided to 1518 children (October: 32; November: 281; December: 583; January: 622).Major challenges included coordination gaps between service activities; space constraints to conduct GMP; overburdening of health assistants to fulfil EPI lost-to-follow-up targets during COVID-19 pandemic and priority for vaccination of COVID-19 to EPI; lack of awareness among caregivers of the importance of appropriate nutrition during the child's first 1000 days for healthy physical and mental development.ConclusionsAlthough this experience suggests integration of GMP into EPI can work, improvements are needed. The MSNP project will increase coordination among donors, Ministry of Health and LGRD, KCC and partner NGOs, service providers and mothers to ensure sustained and effective GMP-EPI integration; provide need-based infant and young child feeding counseling and train caregivers on community-based management of acute malnutrition, and strengthen service provision by providing supportive supervision to them.Funding SourcesUnited States Agency for International Development (USAID).

Assessing the Nurturing Care Content of UNICEF’s Community Infant and Young Child Feeding Counselling Package: Gaps, Best Practices, and Lessons Learned

BackgroundThe United Nations Children’s Fund (UNICEF) Community Infant and Young Child Feeding Counselling Package (C-IYCF CP) is used globally for infant and young child feeding (IYCF) counseling. With the C-IYCF CP last updated 8 y ago, mapping existing nurturing care content, identifying gaps, and documenting current country-level changes offers a unique opportunity to guide recommendations to strengthen the nurturing care content of this package. ObjectivesThe primary study aims were to: 1) identify and map existing nurturing care content within UNICEF’s C-IYCF CP, 2) identify gaps related to nurturing care or feeding elements within the C-IYCF CP, 3) identify country-level nurturing care adaptations to the C-IYCF CP, and 4) identify best practices and lessons learned from country adaptations that can be recommended for inclusion in the C-IYCF CP. MethodsThe assessment included 4 phases: 1) conduct an iterative process to identify and map nurturing care elements within the C-IYCF CP using a codebook explicitly developed for this assessment; 2) identify gaps in the C-IYCF CP; 3) apply the codebook to IYCF packages from 11 countries, revise, then finalize the codebook; and 4) identify and interview key informants from 4 countries whose IYCF packages had the most comprehensive nurturing care content plus 1 country where health care professionals make routine mother–child home visits. ResultsThe C-IYCF CP contained limited nurturing care content, especially around safety/security and early learning. All 5 countries interviewed had systematically identified and included priority nurturing care content in each package, yet content level varied. Two countries were also incorporating information technology into the training and delivery of the C-IYCF CP. ConclusionsExisting country-level best practices can address nurturing care elements missing from UNICEF’s C-IYCF CP. Sharing these practices can allow countries to make context-driven, evidence-informed decisions on the nurturing care content to prioritize.

Increasing Mothers’ Knowledge of Infant and Young Child Feeding through Booklets in Banggai Regency, Central Sulawesi Province, Indonesia

Background: Stunting is caused in part by feeding behavior in infants and young children. Knowledge is the most important factor in shaping one's attitude and behavior, particularly when it comes to infants and young children feeding. This study aims to find out how the mothers’ knowledge of infant and child feeding could be increased through booklets in Banggai Regency, Central Sulawesi Province, Indonesia.&#x0D; Method:&#x0D; This study is a quasi-experimental non-randomized study with pre and post-test only control design. Study was conducted in Jayabakti Village, Banggai Regency. Sample consisted of 40 mothers of children under five collected with purposive sampling method from October to December 2020. At the local Integrated Health Service Post, booklets were distributed once a month as part of the study intervention. Over the duration of the three-month study period, booklets were distributed three times. The used booklets were the modified version of the WHO-developed Infant and Young Child Feeding Counseling: An Integrated Course. The mean difference was used to compare the results of the pre- and post-tests on knowledge of infant and young child feeding. The hypothesis test was applied with a 95% confidence level of 0.05.&#x0D; Result: The respondents with ages ranging between 15 and 20 were 42.5%. Mothers graduated from senior high schools were 45%. Mothers that had three children were 55.0%. Family income was 586,000 rupiahs in average. After the booklets distribution for three months, there was an increase in the mothers’ knowledge regarding infant and young child feeding. The older the mother's age, the better her knowledge (p=0,015). Factors of children's age and mother's education did not have a significant effect.&#x0D; Conclusion:&#x0D; Mothers knowledge regarding infant and young child feeding at Banggai Regency Central of Sulawesi is generally good. After using the booklets, their knowledge has increased. With time, the mother's knowledge expands. Formal education has no significant effect on infants and young children nutrition knowledge

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.

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&lt;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&lt;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&lt;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&lt;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&lt;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.

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.

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.

Breastfeeding Practices and Associated Factors among Mothers of Children Aged 6-23 Months in Konduga Local Government Area, North East Nigeria

Aims: To assess knowledge and practices of breastfeeding as well as identify associated factors among mothers of children aged 6-23 months in Konduga Local Government Area (LGA) in Borno State, Nigeria.&#x0D; Study Design: A descriptive cross-sectional study was conducted among mothers of children aged 6 to 23 months.&#x0D; Place and Duration of the Study: The study was conducted in Konduga LGA of Borno State, Nigeria in August, 2018.&#x0D; Methodology: The study focused on 224 mothers of children aged 6-23 months that have ever assessed the health facility for Micronutrient Powder (MNP) supplementation for their index child. A semi-structured interviewer-administered questionnaire was used to assess socio-demographic characteristics of respondents, knowledge of breastfeeding and their practices of breastfeeding. A point was assigned to correct response to each of the two questions used to assess breastfeeding practices, and respondents with two points were categorized as those with effective breastfeeding practice. Data were analyzed using descriptive statistics, Chi-square test and logistics regression, with the level of significance set at 0.05.&#x0D; Results: A total of 224 respondents were approached for interview and 218 responded, giving a response rate of 97%. Forty-six (21%) of the respondents knew that it is not appropriate to give semi-solid food or water to child that is 4 months old, and 98 (45%) knew that breastfeeding should not be discontinued for a child that is one year of age. Sixty-one (28%) of the respondents practice effective breastfeeding, which was significantly predicted by having formal education (AOR=14.0, 95% CI= 4.0 – 48.6), having a spouse that is educated (AOR=6.0, 95% CI= 2.1- 17.6) and having a male child (AOR=3.2, 95% CI= 1.3 – 8.0).&#x0D; Conclusions: The study findings suggest that effective breastfeeding practice is low among the study participants particularly among the less educated and those having a female child. Interventions targeted at strengthening Infant and Young Child Feeding counseling in the health facility and community are recommended.

Measuring the coverage of nutrition interventions along the continuum of care: time to act at scale.

The global community is committed to addressing malnutrition. And yet, coverage data for high-impact interventions along the continuum of care remain scarce due to several measurement and data collection challenges. In this analysis paper, we identify 24 nutrition interventions that should be tracked by all countries, and determine if their coverage is currently measured by major household nutrition and health surveys. We then present three case studies, using published literature and empirical data from large-scale initiatives, to illustrate the kind of data collection innovations that are feasible. We find that data are not routinely collected in a standardised way across countries for most of the core set of interventions. Case studies—of growth monitoring and screening for acute malnutrition, infant and young child feeding counselling, and nutrition monitoring in India—highlight both challenges and potential solutions. Advancing the nutrition intervention coverage measurement agenda is essential for sustained progress in driving down rates of malnutrition. It will require (1) global consensus on a core set of validated coverage indicators on proven, high-impact nutrition-specific interventions; (2) the inclusion of coverage measurement and indicator guidance in WHO intervention recommendations; (3) the incorporation of these indicators into data collection mechanisms and relevant intervention delivery platforms; and (4) an agenda for continuous measurement improvement.

Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh

ABSTRACTBackgroundAnemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene.ObjectiveWe evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh.DesignWe nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6–24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs.ResultsIn Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102).ConclusionsIYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention.These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).

Effect of breastfeeding education and support intervention (BFESI)\xa0versus routine care on timely initiation and exclusive breastfeeding in Southwest Ethiopia: study protocol for a cluster randomized controlled trial

BackgroundInfant mortality rates are still high in Ethiopia. Breastfeeding is regarded as the simplest and least expensive strategy for reduction of infant mortality rates. Community-based educational and support interventions provided prenatally and postnatally are effective in increasing breastfeeding rates. However, such interventions are not widely implemented in Ethiopia. This study aims to assess the effect of breastfeeding education and support on timely initiation and duration of exclusive breastfeeding.MethodsA cluster-randomized controlled trial at the community level will be conducted to compare the effect of breastfeeding education and support versus routine care. The intervention will be provided by Women Development Army leaders who are already in the country’s health system using a 40-h WHO breastfeeding counseling course, “Infant and Young Child Feeding Counseling: an integrated course” and the “Training of Trainers Manual for Counseling on Maternal, Infant and Young Child Nutrition” in the local language. Culturally appropriate operational packages of information will be developed for them. Using preset criteria at least 432 pregnant women in their third trimester will be recruited from 36 zones. Visits in the intervention arm include two prenatal visits and 8 postnatal visits. Supervisory visits will be conducted monthly to each intervention zone. Data will be entered into Epi-data version 3.1 and analyzed using STATA version 13.0. All analysis will be done by intention to treat analysis. We will fit mixed-effects linear regression models for the continuous outcomes and mixed-effects linear probability models for the binary outcomes with study zone as random intercept to estimate study arm difference (intervention vs. routine education) adjusted for baseline value of the outcome and additional relevant covariates. The protocol was developed in collaboration with the Jimma Zone and Mana district Health office. Ethical clearance was obtained from the Institutional Review Board of University of Oslo and Jimma University. This study is partly funded by NORAD’s NORHED programme.DiscussionWe expect that the trial will generate findings that can inform breastfeeding policies and practices in Ethiopia.Trial registrationClinicalTrials.govNCT 03030651 January 25, 2017 version 3 dated 16 July 2018.