Few trials have shown that promoting complementary feeding among young children is effective in improving child linear growth in resource-challenged settings. We designed a community-based participatory nutrition promotion (CPNP) programme adapting a Positive Deviance/Hearth approach that engaged mothers in 2-week nutrition sessions using the principles of 'learning by doing' around child feeding. We aimed to test the effectiveness of the CPNP for improving child growth in rural Ethiopia. A cluster randomized trial was implemented by adding the CPNP to the existing government nutrition programmes (six clusters) vs. government programmes only (six clusters). A total of 1790 children aged 6 to 12 months (876 in the intervention and 914 in the control areas) were enrolled and assessed on anthropometry every 3 months for a year. Multi-level mixed-effect regression analysis of longitudinal outcome data (n = 1475) examined the programme impact on growth, adjusting for clustering and enrollment characteristics. Compared with children 6 to 24 months of age in the control area, those in the intervention area had a greater increase in z scores for length-for-age [difference (diff): 0.021 z score/month, 95% CI: 0.008, 0.034] and weight-for-length (diff: 0.042 z score/month, 95% CI: 0.024, 0.059). At the end of the 12-month follow-up, children in the intervention area showed an 8.1% (P = 0.02) and 6.3% (P = 0.046) lower prevalence of stunting and underweight, respectively, after controlling for differences in the prevalence at enrollment, compared with the control group. A novel CPNP programme was effective in improving child growth and reducing undernutrition in this setting. © 2016 John Wiley & Sons Ltd.

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Appropriate complementary feeding and hygiene may reduce child undernutrition. We designed a community‐based participatory nutrition promotion (CPNP) program, adopting in part the theory of positive deviance, in Ethiopia. This program through group sessions engaged mothers in “learning by doing” around infant feeding and hygiene and utilization of affordable resources. This program was implemented in addition to the existing government nutrition programs and tested in a cluster‐randomized trial to examine its effectiveness in improving child growth. 1,790 children 6 to 12 months of age were enrolled in the trial and measured for their height and weight every three months for 12 months. 38.9% of children enrolled in the intervention area attended the CPNP program. In multi‐level mixed‐effect regression models based on longitudinal data controlling for clustering effects, children in the intervention area had a significantly greater length‐for‐age z score (LAZ)/month of 0.017 (95% CI 0.004, 0.030) and weight‐for‐age z score (WAZ)/month of 0.015 (95% CI 0.003, 0.026) compared to children in the control area. Significant differences in LAZ and WAZ scores between two groups were apparent after 6 months of program implementation and continued up to a year. Stunting, underweight, and wasting were 5–7 percentage points lower in the intervention area than the control area after a year. This new program approach was effective in improving child growth in the rural Ethiopian context. This trial was funded by KOICA, World Vision Korea, and WITH.

Adding amylase to Super Cereal Plus (SC+A) improves energy and nutrient intake as porridge energy density reaches 1.0 kcal/g, meeting the recommended ≥0.8 kcal/g for prepared foods for young children. Caregiver response to SC+A in terms of adjusting porridge preparation using printed pictogram instructions was not yet investigated. The study assessed (a) porridge preparation by caregivers; (b) porridge energy density; (c) sensory porridge acceptability; and (d) understanding of preparation instructions. An 8‐day follow‐up intervention study was conducted amongst caregivers of children aged 6–23 months ( n = 238) in Rwanda. Caregivers prepared porridge using SC+A whilst referring to printed pictogram instructions at the study site on Days 1 and 8 and received flour for preparation at home on Days 2–7. At the site, data were collected on porridge preparation procedures, energy density, consistency, acceptability, and interviews ( n = 12), and focus group discussions ( n = 6) were conducted. Mean porridge dry matter (DM) increased from 21.3 ± 4.4% (Day 1) to 25.1 ± 4.8% (Day 8; p < 0.0005). Flour and water were mixed before cooking by 95% of the participants, as per printed instructions. Sensory porridge acceptability was high, and the printed instructions enabled caregivers to prepare an accepted and energy dense porridge. The preferred water/flour volume ratio was 2.5 instead of 3. In conclusion, Rwandan caregivers prepared well‐accepted SC+A porridges with a preferred consistency and mean DM content of 25.1% (1.0 kcal/g), after 1 week practicing at home. This supports introducing SC+A with the tested instructions at scale.