Scaled-up nutrition education on pulse-cereal complementary food practice in Ethiopia: a cluster-randomized trial

Abstract

Background Improving children’s weight status through nutrition education (NE) for mothers about using pulses in complementary feeding has been demonstrated in pilot studies, but no effect on stunting was reported. The aim of the study was to assess the impact of a 9-month pulse-nutrition education program on improving mothers’ knowledge, attitude, and practices (KAP) towards pulses, as well as its effect on children’s diet diversity, and nutritional status. The NE was delivered by Health Extension Workers (HEWs). Methods A cluster randomized study was employed for the community-based interventional study. Twelve randomly selected villages in Sidama Zone, Southern Ethiopia were included in the study. A total of 772 mother-child pairs involved in the study; where 386 mother-child pairs in the intervention group received additional messages about pulse-cereal complementary food, and 386 pairs (the control) received only routine health education for 9 months. A survey on mothers’ KAP and anthropometric measurements of the children were taken at baseline, midpoint, and end point. ANOVA and descriptive statistics were used to analyzed data. Results At baseline and end point, maternal KAP and the dietary diversity score of the children (mean age at end point 18.8 ± 2.9 mo) were assessed. Intervention mothers’ KAP improved (p < 0.001) at midpoint and end point compared to that of the control group, as did frequency of pulse consumption and Dietary Diversity Score (DDS) among children. At 9 months, the prevalence of stunting, wasting, and underweight was significantly reduced in the intervention group compared to the control group (p = 0.001). Conclusions NE delivered by HEWs improved KAP of mothers regarding pulse consumption and dietary diversity of children led to improved nutritional status of the children. Training HEWs on the use of pulses for complementary food may be an effective way to improve the health of children in Ethiopian communities. Trial registration Clinicaltrials.gov #NCT02638571. Date of registration: 12/18/2015. Prospectively registered.

Knowledge, Attitudes, and Barriers towards Dietary Pulse Consumption in Women with Polycystic Ovary Syndrome Participating in a Multi-Disciplinary Lifestyle Intervention to Improve Women’s Health

“…We attributed improved knowledge of the pulse-based diet group to a greater awareness of pulses through education and receiving pulses in their meals over 16 weeks. Furthermore, we provided education about the benefits of adopting healthy lifestyle practices, including diet to all women as a standard of care [32], which likely contributed to improved attitudes of both groups about pulse consumption as a component of healthy dieting, similar to previous reports [39,[46][47][48][49]. In addition to improved pulse consumption behaviours, we have previously shown the benefits of pulse foods on cardiometabolic (e.g., dyslipidaemia, impaired glucoregulatory status) and reproductive (e.g., menstrual regulatory, hyperandrogenism, and ovarian morphology) derangements in women with PCOS following healthcare counselling and education [18,19].…”

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

“…A total of 23 studies were included, and of these, 14 were quasi-experimental studies, 74-87 and 9 were cluster randomised trials. [88][89][90][91][92][93][94][95][96] Four studies for EBF 77 83 85 91 and six studies for EIBF 77 79 80 85 86 91 showed that community-based and facility-based interventions delivered in the form of BCC (such as policy advocacy, interpersonal communication, community mobilisation and mass media campaigns) and health service strengthening had an impact on infants. Two studies for the introduction of complementary foods, 79 93 six studies for MDD 79 89 90 92 94 96 and three studies for MMF 88 89 92 indicated significant effects of BCC on infants and young children.…”

“…Tariku et al 90 showed interventions involving complementary feeding messages using the HBM model significantly increased the proportion of MDD (from 37.5% to 67.9%; p<0.05). End line survey results following the intervention of nutritional education and counselling, and recipe demonstrations by Muluye et al (67.0% vs 33.0%, p=0.034) 94 and Teshome et al (51.5% vs 43.3%; p=0.001) 96 showed significant differences in the proportion of MDD between intervention and control groups. The remaining four studies indicated that the proportion of MDD increased over the intervention period, but the effect was not significant.…”

“…Among the 23 included studies, 14 were quasiexperimental studies, [74][75][76][77][78][79][80][81][82][83][84][85][86][87] while the remaining 9 were cluster randomised trials. [88][89][90][91][92][93][94][95][96] At least one interventional study was conducted in Southern Nations Nationalities and Peoples' Region (SNNPR), 77-79 81 82 84-86 90 Oromia, 74 77 78 83-88 91 95 Amhara, 76-78 84-87 89 92 93 95 Tigray 77 79 84-87 95 and Afar 80 regions, but we did not find published interventional studies conducted in either Addis Ababa and Dire Dawa city administrations, Harari, Benishangu1, Gambella, or Somali regions.…”

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

“…On the other hand, community-based studies related to germination have focused on testing community acceptability with mothers [ 37 , 38 ] through cooking demonstrations by Health Extension Workers (HEWs) [ 39 ]. These studies did not examine how best to upskill mothers and the broader community in the food processing skills required to produce ARF or the opportunities and challenges of scaling up skill development in the community using existing peer support networks.…”