Effect of behavioural change communication through women development army on optimal complementary feeding practice among children aged 6-23 months in Southwest Ethiopia: a cluster randomized controlled trial.
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Abstract
Background: Optimal development and growth in children are primarily determined by dietary practice during the first 24 months of life. However, in low-income countries, especially in sub-Saharan Africa, ensuring adequate nutrition and maternal nutritional knowledge are challenging. As a result, it is a major public health issue in Ethiopia. Therefore, it is essential to address feeding practices and knowledge gaps through behavior change communication. This study assessed the effect of behaviour change communication through the women's development army on complementary feeding practices among children aged 6-23 months in Jimma Zone, Ethiopia.
Methods: A cluster randomized controlled trial was conducted from December 2021 to November 2022 in rural Ethiopia. The study used two-stage cluster sampling to allocate villages into control and intervention groups and systematic random sampling methods to select participants. Fourteen villages were randomly chosen from 21 eligible ones, with seven clusters (villages) in each group. Initially, 438 mother-child pairs participated, and 404 pairs remained at the endline data collection. The intervention group, consisting of 219 pairs, received food-based BCC from the WDA, while the control group, also with 219 mother-child pairs, received routine health education by Health Extension workers. Data were collected through structured questionnaires and 24-hour dietary recall. The primary objective for this study was optimal complementary feeding practices. The chi-square statistic assessed sociodemographic differences, and the difference-in-differences method evaluated the intervention's effect. Generalized estimating equations were used to analyze BCC's impact and identify predictors.
Results: The intervention group showed a 28.4% (DID: 28.4%, 95% CI: 18.1 to 38.6) improvement in optimal complementary feeding practices compared to the control group (p < 0.001). Factors associated with optimal complementary feeding practices included BCC (AOR = 5.00, 95% CI: 1.78-14.05), maternal education (AOR = 2.00, 95% CI: 1.33-3.01), not using traditional food processing methods (AOR = 0.34, 95% CI: 0.21-0.54), and maternal knowledge (AOR = 0.65, 95% CI: 0.43-0.99).
Conclusion: BCC, through the WDA, significantly improved complementary feeding knowledge and practices. Policymakers should support long-term BCC interventions and adopt a multi-sectoral approach to address the factors influencing child feeding practices. The study is registered retrospectively in the Pan African Clinical Trials Registry with number PACTR202106621156513 on 21/06/2021.
期刊介绍：
Nutrition Journal publishes surveillance, epidemiologic, and intervention research that sheds light on i) influences (e.g., familial, environmental) on eating patterns; ii) associations between eating patterns and health, and iii) strategies to improve eating patterns among populations. The journal also welcomes manuscripts reporting on the psychometric properties (e.g., validity, reliability) and feasibility of methods (e.g., for assessing dietary intake) for human nutrition research. In addition, study protocols for controlled trials and cohort studies, with an emphasis on methods for assessing dietary exposures and outcomes as well as intervention components, will be considered.
Manuscripts that consider eating patterns holistically, as opposed to solely reductionist approaches that focus on specific dietary components in isolation, are encouraged. Also encouraged are papers that take a holistic or systems perspective in attempting to understand possible compensatory and differential effects of nutrition interventions. The journal does not consider animal studies.
In addition to the influence of eating patterns for human health, we also invite research providing insights into the environmental sustainability of dietary practices. Again, a holistic perspective is encouraged, for example, through the consideration of how eating patterns might maximize both human and planetary health.
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