Community-based educational intervention improved the diversity of complementary diets in western Kenya: results from a randomized controlled trial

Abstract

Objective: Lack of diversity is a major factor contributing to inadequate nutrient intakes among children during the complementary feeding period in many rural areas in developing countries. This has been attributed to inadequate feeding practices and nutrition knowledge among their caregivers. The aim of the present study was to assess the effect of an educational intervention on children's dietary diversity and nutrition knowledge of caregivers. Design: Cluster randomization was applied and twenty matched village pairs were randomly assigned to the intervention or control group. The nutrition education intervention consisted of four sessions comprising of group trainings and cooking demonstrations that were conducted over a period of 5 months. Setting: Households in rural communities in Bondo and Teso South sub-counties, western Kenya. Subjects: Caregivers with children aged 6-17 months receiving nutrition education. Results: The children's dietary diversity scores (CDDS) and nutrition knowledge scores of the caregivers improved significantly in the intervention group at endline. The treatment effect on CDDS was positive and significant (P = 0·001). The CDDS rate of the children in the intervention group was 27 % larger than it would have been without the treatment effect. The intervention also had a significant effect on the caregivers' nutrition knowledge scores (incidence rate ratio = 2·05; P < 0·001). However, the nutrition knowledge of the caregivers did not have a significant effect on CDDS (P = 0·731). Conclusions: The nutrition education intervention led to improvements in children's dietary diversity and nutrition knowledge of the caregivers. Keywords Nutrition education Complementary feeding Dietary diversity Caregivers InterventionMalnutrition among children under 5 years of age is still a widespread problem in many developing countries. Worldwide, approximately 162 million children under 5 years are stunted, while 99 million and 51 million are underweight and wasted, respectively (1) . An analysis of data from the Kenya Demographic and Health Surveys (KDHS) over the last three decades shows that there has been a slow decline in the prevalence of malnutrition among young children in Kenya (2,3) . Data from the 2008-2009 KDHS showed that in Kenya, 35 % of children aged <5 years were stunted, 16 % were underweight and 7 % were wasted. The prevalence of stunting was highest (46 %) among children aged 18-24 months and 42 % among those aged 6-12 months. Stunting rates were highest among children living in rural areas (37 %) compared with those living in urban areas (26 %) (4) .While the causes of malnutrition are complex, inappropriate feeding practices during the complementary feeding period have been identified as major factors contributing to inadequate nutrient intakes among infants and young children (5)(6)(7)(8)(9) . While consuming a variety of foods is important for meeting essential nutrient requirements needed to promote growth, traditional diets fed to children in developing countries ...

Impact of type of child growth intervention program on caregivers’ child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana

“…Contrary to findings from Waswa et al. (), this study and others have shown that nutrition knowledge of caregivers positively predicts adequate dietary intakes of infants (Dewey and Adu‐Afarwuah ; Inayati et al. ).…”

Effect of nutrition education on the knowledge scores of urban households with home gardens in Morogoro, Tanzania

“…Here, the respondents improved their practical knowledge, in terms of being better able to name foods rich in the respective nutrients. This is in accordance with studies which showed that practical nutrition knowledge played a greater role in the nutrition outcomes as compared to the education level of the mother [36,37].…”

Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets

“…For instance, Appoh and Krekling (2005) found that impact of maternal nutritional knowledge on child nutrition status was greater than that of formal education. This is to say that even those caregivers who do not have formal education can still realize better nutritional outcomes for their vs. 51.9%, P < 0.001), the increase in DDS was not associated with the observed increase in maternal nutrition knowledge (Waswa, Jordan, Herrmann, Krawinkel, & Keding, 2015). The authors conclude that effect of the intervention on child dietary diversity was not via an increase in nutrition knowledge of the caregivers per se and that although increased nutrition knowledge is an important factor, on its own, it cannot lead to changes in behaviours.…”

“…In a randomized‐cluster controlled trial on the effect of nutrition education focusing on the utilization of local agro‐biodiversity in improving the diversity of children's complementary diets and nutrition knowledge of caregivers, the researchers noted that although a significantly higher proportion of children in the intervention group compared with those in the control group achieved minimum dietary diversity (87.3% vs. 55.7%, P < 0.001); minimum meal frequency (98.8% vs. 88.6%, P = 0.019); and minimum acceptable diet (87.8% vs. 51.9%, P < 0.001), the increase in DDS was not associated with the observed increase in maternal nutrition knowledge (Waswa, Jordan, Herrmann, Krawinkel, & Keding, ). The authors conclude that effect of the intervention on child dietary diversity was not via an increase in nutrition knowledge of the caregivers per se and that although increased nutrition knowledge is an important factor, on its own, it cannot lead to changes in behaviours.…”