Designing a Scalable Nutrition Education Package to Improve Diets of Adolescent Girls Through Primary Schools in Ethiopia

OBJECTIVES: Improving adolescent girls' nutrition is a high priority for the government of Ethiopia due to its immediate benefits for girls' education and foundational role in protecting the productive and reproductive lives of women. Alive and Thrive (A&T) aimed to develop and implement an effective nutrition education package for scaling up by government education and health authorities. METHODS: We applied the socio-ecological model of social behavior change to systematically develop and test contextualized nutrition interventions in Southern Nations, Nationalities, and Peoples' (agrarian) and Somali (pastoralist) regions. Using multiple sources of data and information we identified gaps in dietary practices, barriers, motivations; influential persons; and channels of communication for reaching adolescent girls in primary schools and influential persons, at high coverage and with frequent contacts. Region specific interventions, protocols, tools, and materials were field tested and tailored to fit the contact points and capacity of schools. RESULTS: Three dietary practices were selected based on evidence of gaps and potential benefits, 1) dietary diversity through promotion of locally available foods and food groups missing from adolescent girls' diets by region, 2) frequency of meals and 3) reducing the consumption of unhealthy foods. Teachers, parents and peers were found to have the greatest influence on adolescent girls' dietary practices. Community leaders (including religious leaders in Somali) and health extension workers were influential among parents, and school principals and supervisors were important for motivating teachers. CONCLUSIONS: Systematically targeting priority behaviors, engaging key influential persons, achieving high coverage and frequency through existing multiple contact points, and utilizing communication channels available through in-classroom and other activities were critical for developing a feasible and scalable package of school-based nutrition education interventions. Using data to design interventions and streamline implementation strategies facilitated the scale up of an effective intervention package for schools. FUNDING SOURCES: Bill & Melinda Gates Foundation, through A&T, managed by FHI Solutions.