Effectiveness of the women’s development team leaders in delivering nutrition education on pulse sprouting in Southern Ethiopia

Abstract

Effectively implemented nutrition education can provide participants with the knowledge and skills to make healthy food choices in the context of their lifestyles and economic resources. In Ethiopia, the government equips health extension workers (HEWs) to provide nutrition education to communities by enabling HEWs to transfer knowledge to women's development team leaders (WDTLs) who in turn share the knowledge with the one-to-five network leaders (1-5NWL) and members. The objective of this study was to examine the effectiveness of WDTLs in delivering nutrition education to women as the intervention group (IG). This was compared to having trained HEWs educate women directly (the positive control group, PCG), and having women receive no specific education (negative control group, NCG). A cluster randomized trial design was used. Three kebeles (villages of 5000 people) were purposively selected from which the WDTLs were randomly selected and their respective 1-5NWL and members were participants. Nutrition education to teach pulse sprouting was provided every other week for 6 months to intervention and positive control groups. Focus group discussions and demonstrations were held to reinforce knowledge and skills. Knowledge, attitude and practice (KAP) of the women were evaluated pre and post-intervention. At baseline all three groups had similar low scores in KAP. After the education intervention, knowledge improved in IG compared to PCG (p=0.009), and both were greater than NCG (p=0.001). Attitude in IG improved more in PCG (p=0.008) and both increased compared to NCG (p=0.001). Practices improved, similarly, in IG and PCG (p=0.084) after intervention, and both were better than NCG (p=0.001). From this study, we conclude that nutrition education delivered through WDTLs, as is intended in communities in Ethiopia having HEWs, was more effective than delivery by HEWs alone. Nutrition education on pulse sprouting has the potential to bring positive changes on KAP of rural women who depend on this processing skill to provide nutritious foods for their families.

The Facilitators and Barriers of Adopting Amylase-Rich Flour to Enhance Complementary Foods in the Kersa District Community of Eastern Ethiopia

“…Germination is an indigenous food processing method [ 44 ] used in Ethiopia [ 45 ] but with a low rate of use for complementary foods. This holds for our study and Southern Ethiopia [ 46 ]. Key to its acceptability, religious leaders and HDA leaders favoured germinated grain flour to improve complementary foods.…”

“…The productivity of community health workers such as HEWs and HDA leaders depends on knowledge and skills, motivation, and their work environment (supportive supervision and workload) [ 56 ]. In this regard, unlike Mulualem et al [ 50 ] and other studies [ 20 , 21 , 29 , 30 , 46 , 50 , 51 ] that examined ARF use in complementary foods using existing health delivery platforms, our study has reported opportunities and challenges surrounding ARF implementation from HDA leaders’ perspectives.…”

“…On top of understanding the cultural context, successful expansion of ARF skills requires an appropriate implementation platform [ 53 ]. In line with a study conducted in Southern Ethiopia that delivered pulse sprouting education through women’s development team leaders, our study used a similar structure [ 46 ]. However, Hailu et al [ 46 ] relied on self-reported use of pulse germination, and it was not verified with observation [ 46 ].…”

“…In line with a study conducted in Southern Ethiopia that delivered pulse sprouting education through women’s development team leaders, our study used a similar structure [ 46 ]. However, Hailu et al [ 46 ] relied on self-reported use of pulse germination, and it was not verified with observation [ 46 ]. The findings of this study showed that the HDA leaders cascaded their ARF skill to available members, which they were supposed to deliver through the one-to-five networks, a structure key to adopting the improved practices [ 43 ].…”