Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia

Abstract

Background Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM). Objectives The aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes. Methods We used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6–23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose–response and path analyses to document plausibility of impacts. Results At endline, exposure to IPC was 17.8–32.3%, exposure to AG was 22.7–36.0%, exposure to CM was 18.6–54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose–response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ. Conclusions Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

Interventions to Improve Infant and Young Child Feeding Practices in Ethiopia: A Systematic Review  

“…The rst arm of the study found an increase in the proportion of infants who were introduced to solid, semi-solid and soft foods (from 37.4-59.7%, P-value < 0.001) [58]. In contrast, the second arm of the study did not nd a signi cant improvement (from 58.7-61.3%, P-value > 0.05) [64].…”

“…Three cluster randomised trials were assessed for risk of bias using the Cochrane RoB 2.0 tool. Overall, studies by Kang et al and Tariku et al judged as some concerns in the risk of bias [63,65], and the remaining study by Kim et al had a low risk of bias [64]. All cluster randomised trials had a low risk of bias in randomisation, missing data, and reporting of results.…”

“…Among the 13 included studies, ten were quasi-experimental studies [53][54][55][56][57][58][59][60][61][62], while the remaining three were cluster randomized trials [63][64][65]. At least one interventional study was conducted in Sothern Nations Nationalities and Peoples' Region (SNNPR) [56-58, 60, 61, 65], Oromia [53,56,57,62,66], Amhara [55][56][57]64], Tigray [56,58], and Afar [59] regions, but we did not nd published interventional study conducted in Addis Ababa and Dire Dawa city administrations, as well as Harari, Benishangu1, Gambella, or Somali regions.…”

“…In the eligible studies, the majority of the interventions were provided in the form of behaviour change communication (BCC) using nutrition education [60,61], community mobilisation [55,57,64], health education materials [53,59,61,62], and mass media communication [58,64]. Other interventions were also provided in the form of strengthening of health care system [57,59], training and supervision of health care providers [55,57,62], and food preparation and demonstration sessions [60,61,63].…”

“…Of these, three measured according to the WHO de nitions for MDD [58,64,65], while the remaining two studies used any four food groups as a cut-off point to measure MDD [61,63]. Two studies by Kim et al revealed the signi cant impacts of exposure to more than one type of BCC interventions (advocacy and policy dialogues, interpersonal communication and community mobilization, and mass communication) on MDD, but these studies showed that exposure to a single type of intervention did not have an impact on MDD [58,64]. Tariku et al showed interventions involving complementary feeding messages using the HBM model signi cantly increased the proportion of MDD (from 37.5-67.9%, Pvalue < 0.05) [65].…”