Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children’s Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria

Abstract

Background Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers. Objective To measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers’ and mothers’ complementary feeding knowledge, and fathers’ support for complementary feeding (secondary outcomes). Methods The 12-month intervention in Kaduna State, Nigeria engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child 6-23 months were conducted, and regression models were used to compare results at baseline (N = 497) and endline (N = 495). Results Children's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P<0.001) increased. Fathers’ and mothers’ knowledge of the timing of introduction of different foods and meal frequency improved. Fathers’ support for child feeding by providing money for food increased (79% to 90%, P<0.001). Fathers’ and mothers’ reported intervention exposure was low (11%-26% across types of SBCC). Child feeding outcomes were not associated with fathers’ exposure, but odds of both fish and egg consumption increased significantly with mothers’ exposure to community meetings, religious services, home visits, and TV spots and odds of minimum meal frequency increased significantly with mothers’ exposure to home visits. Conclusions A multipronged SBCC intervention improved complementary feeding practices, fathers’ and mothers’ knowledge of complementary feeding, and fathers’ support for complementary feeding, despite low levels of reported exposure, which may have been influenced by COVID-19 disruptions. Registered with ClinicalTrials.gov (NCT04835662).

Fathers’ Complementary Feeding Support Strengthens the Association Between Mothers’ Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria

“…The radio and TV ads were aired 7–8 times per day. Findings from the evaluation of the intervention, which have been documented elsewhere ( 25 ), show low reported exposure to the intervention components, with fathers’ reported exposure ranging from 11% to 26% and mothers’ reported exposure ranging from 12% to 21%. Mothers who reported exposure to intervention messages through CBOs, religious services, home visits, and on TV had increased odds of feeding their children eggs and fish the previous day.…”

“…The 2008 WHO IYCF guidelines for calculating minimum dietary diversity were used for this study because the 2021 WHO IYCF recommendations were not available when the study was designed and conducted. In addition to these indicators, consumption of 2 specific food groups on the previous day (feeding eggs and fish to children aged 6–23 mo), which had been promoted by the intervention ( 25 ), yielded post hoc outcome variables.…”

Effectiveness of the Eggs Make Kids demand‐creation campaign at improving household availability of eggs and egg consumption by young children in Nigeria: A quasi‐experimental study

“…In July 2019, Alive & Thrive launched a campaign in Kaduna state promoting complementary feeding, including egg consumption among children (Flax et al, 2022), which could explain the high rates of self-reported exposure to egg promotion messaging in both states at baseline, as the two states are geographically close and the mass media campaign in Kaduna (i.e., television and radio spots) may have reached our study's comparison state of Kano. Similar spillover of mass media messages directed at the intervention state reaching the comparison state could have occurred in our study.…”

“…Interventions such as this one may benefit from coupling their ATL and BTL activities with interpersonal communication from, for example, trusted sources of information such as community health workers and religious leaders, to encourage changes in intrahousehold allocation of eggs and the transition from caregiver awareness and self‐efficacy to the practice of feeding eggs to children. In a recent study in Nigeria, complementary feeding social and behaviour change communication targeting both fathers and mothers increased children's consumption of eggs, fish and minimum meal frequency (Flax et al, 2022 ). This type of intervention illustrates the importance of directing messages at fathers and of interpersonal communication through community meetings, religious services and home visits, in addition to mass media, to effectively influence behaviour change.…”

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

“…Interventions were coded on the basis of involving one or more Behaviour Change Wheel intervention functions ( Fig 1 ) [ 28 ]. Functions ( S3 Table ) included education(n = 56) [ 20 , 42 – 44 , 47 – 50 , 52 , 54 – 57 , 58 , 60 , 70 – 81 , 83 , 84 , 87 , 89 – 94 , 103 – 105 , 107 – 112 , 115 – 121 ], enablement(n = 56) [ 20 , 42 , 47 – 50 , 52 , 54 – 57 , 58 , 61 – 72 , 75 – 82 , 85 , 86 , 89 – 91 , 93 , 94 , 96 , 98 – 107 , 109 , 113 – 115 , 117 , 119 – 121 ], persuasion(n = 46) [ …”