Background Sub-optimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition, however in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated. Objectives We examine how an innovative grandmother-inclusive approach (GMIA) can be used to address sub-optimal IYCF practices. Methods Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children < 2 y of age, and 219 grandmothers. Statistical analyses utilized t-tests and chi square to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest. Results Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children 0–23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% vs. 79.4%, p = 0.01). Among infants 6–23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% vs. 51.8%, p < 0.001 and 53.8% vs. 22.6%, p < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants 9–23 mo, with intervention group achieving higher MMF (54.6% vs. 36.9%, p = 0.02). Conclusions Results suggest that a GMIA that recognizes grandmothers’ roles and strengthens their knowledge may contribute to improved IYCF practices.

Poor nutrition and health seeking practices of pregnant and lactating women contribute to maternal morbidity, poor birth outcomes and undernutrition of children in Sierra Leone. We examined how a grandmother (GM) inclusive approach to nutrition‐related social and behavior change affected maternal diet and health seeking practices in southern Sierra Leone. The GM‐inclusive approach is grounded in formative ethnographic research and builds on GMs' culturally‐designated role as advisors and caregivers and aims to strengthen their knowledge and confidence to promote positive change for maternal and child health. Following mixed methods formative research, World Vision implemented a quasi‐experimental proof of concept study in two sections in the Bum Chiefdom, Bonthe Sierra Leone. The villages of one section received the grandmother‐inclusive approach consisting of monthly participatory nutrition education sessions with GMs, quarterly community praise sessions focused on the attributes of and supportive roles of GMs, the identification and support of GM leaders as change agents for maternal and child health and intergenerational forums. Villages in the control section received the standard of care for nutrition education provided by the Ministry of Health. The endline survey utilized a census based sampling strategy and surveyed all women in the study communities who were pregnant (PW, N=101) or had a child less than 2 years of age (MU2, N=291). Data were collected on household sociodemographics, maternal diet and IYCF knowledge, attitudes, and intentions/practices. Preliminary analyses examined differences in proportions between intervention and comparison participants with chi‐square. The proportions of MU2 (94.6% vs. 67.3%, P<0.001) and PW (96.3% vs 61.7%, P<0.001) achieving minimum dietary diversity in the previous 24 hours were significantly higher in the intervention compared to the comparison group. As well, a significantly greater proportion of PW in the intervention group intended to consume more food (88.9% vs 48.9%, P<0.0001) and work less (94.4% and 88.1%, P=0.002) during their current pregnancy. Similarly, a significantly greater proportion of MU2 in the intervention group reported increased meal frequency (94.6% vs 63.6%, P<0.001) and decreased work (91.3% vs 75.7%, P<0.001) during their most recent pregnancy. A greater proportion of MU2 in the intervention communities also reported attending ANC at least 4 times (97.1% vs. 80.8%, P<0.001) and delivering in a health facility (96.7% vs 90.7%, P=0.03). Few studies have shown improved nutrition practices during pregnancy, and particularly during crisis (e.g., Ebola). Preliminary analyses suggest that a grandmother‐inclusive approach that recognizes GMs' role in nutrition and health and strengthens their knowledge can contribute to improved nutrition and health practices during pregnancy improved nutrition and health practices in pregnancy.Support or Funding InformationFunding provided by World Vision Canada, World Vision Germany, World Vision Sierra Leone and the Emory University Global Field Experiences Program

Suboptimal infant and young child feeding (IYCF) practices contribute to child undernutrition in Sierra Leone. We examined whether a grandmother‐inclusive approach to nutrition‐related social and behavior change could improve maternal diet and IYCF outcomes in southern Sierra Leone. The GM‐inclusive approach is grounded in formative ethnographic research and builds on GMs' culturally‐designated role as advisors and caregivers and aims to strengthen their knowledge and confidence to promote positive change for maternal and child health. Following mixed methods formative research, World Vision implemented a quasi‐experimental proof of concept study in two sections in the Bum Chiefdom, Bonthe Sierra Leone. The villages of one section received the grandmother‐inclusive approach consisting of monthly participatory nutrition education sessions with GM, quarterly community praise sessions focused on the attributes of and supportive roles of GM, the identification and support of GM leaders as change agents for maternal and child health and intergenerational forums. Villages in the control section received the standard of care for nutrition education provided by the Ministry of Health. The endline survey utilized a census based sampling strategy and surveyed all women in the study communities who were pregnant or had a child less than 2 years of age. Data were collected on household sociodemographics, maternal diet and IYCF knowledge, attitudes, and intentions/practices. Preliminary analyses examined differences in proportions between intervention and comparison participants with chi‐square. At endline, infants (n=291) were on average 11.8± 6.9 months of age and 52.2% were female. The proportion of 0–23 month olds exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% vs 79.4%, P=0.01) but there were no statistically significant differences in other breastfeeding practices. Among infants 6–23 months, the proportion achieving minimum dietary diversity (77.2% vs 51.8%, P<0.001) and minimum acceptable diet (53.8% vs 22.6%, P<0.001) was significantly higher in the intervention group. Differences in the proportions achieving minimum meal frequency were only significant for infants 9–23 months of age with a greater proportion of infants in the intervention group achieving minimum meal frequency (54.6% vs 36.9%, P=0.02). Preliminary analyses suggest that a grandmother‐inclusive approach that recognizes GMs' role in child nutrition and health and strengthens their knowledge can contribute to improved IYCF practices.Support or Funding InformationSupport provided by World Vision Canada, Nutrition Centre of Expertise, World Vision Germany, World Vision Sierra Leone and the Emory University Global Field Experiences Program.