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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...

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Autores principales: Kim, Sunny S, Nguyen, Phuong Hong, Yohannes, Yisehac, Abebe, Yewelsew, Tharaney, Manisha, Drummond, Elizabeth, Frongillo, Edward A, Ruel, Marie T, Menon, Purnima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
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.
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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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