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Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia
BACKGROUND: Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersona...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686053/ https://www.ncbi.nlm.nih.gov/pubmed/31165869 http://dx.doi.org/10.1093/jn/nxz087 |
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author | Kim, Sunny S Nguyen, Phuong Hong Yohannes, Yisehac Abebe, Yewelsew Tharaney, Manisha Drummond, Elizabeth Frongillo, Edward A Ruel, Marie T Menon, Purnima |
author_facet | Kim, Sunny S Nguyen, Phuong Hong Yohannes, Yisehac Abebe, Yewelsew Tharaney, Manisha Drummond, Elizabeth Frongillo, Edward A Ruel, Marie T Menon, Purnima |
author_sort | Kim, Sunny S |
collection | PubMed |
description | BACKGROUND: Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM). OBJECTIVES: The aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes. METHODS: We used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6–23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose–response and path analyses to document plausibility of impacts. RESULTS: At endline, exposure to IPC was 17.8–32.3%, exposure to AG was 22.7–36.0%, exposure to CM was 18.6–54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose–response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ. CONCLUSIONS: Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552. |
format | Online Article Text |
id | pubmed-6686053 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-66860532019-08-14 Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia Kim, Sunny S Nguyen, Phuong Hong Yohannes, Yisehac Abebe, Yewelsew Tharaney, Manisha Drummond, Elizabeth Frongillo, Edward A Ruel, Marie T Menon, Purnima J Nutr Original Research Article BACKGROUND: Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM). OBJECTIVES: The aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes. METHODS: We used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6–23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose–response and path analyses to document plausibility of impacts. RESULTS: At endline, exposure to IPC was 17.8–32.3%, exposure to AG was 22.7–36.0%, exposure to CM was 18.6–54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose–response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ. CONCLUSIONS: Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552. Oxford University Press 2019-08 2019-06-05 /pmc/articles/PMC6686053/ /pubmed/31165869 http://dx.doi.org/10.1093/jn/nxz087 Text en Copyright © American Society for Nutrition 2019. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Research Article Kim, Sunny S Nguyen, Phuong Hong Yohannes, Yisehac Abebe, Yewelsew Tharaney, Manisha Drummond, Elizabeth Frongillo, Edward A Ruel, Marie T Menon, Purnima Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia |
title | Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia |
title_full | Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia |
title_fullStr | Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia |
title_full_unstemmed | Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia |
title_short | Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia |
title_sort | behavior change interventions delivered through interpersonal communication, agricultural activities, community mobilization, and mass media increase complementary feeding practices and reduce child stunting in ethiopia |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686053/ https://www.ncbi.nlm.nih.gov/pubmed/31165869 http://dx.doi.org/10.1093/jn/nxz087 |
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