Impact Evaluation of a Multi-Sectoral Community-Based Approach to Improving Infant and Young Child Feeding in Amhara, Ethiopia
Condition: Exclusive Breastfeeding; Complementary Feeding
Study type: Interventional

Summary: 
      Alive & Thrive is an initiative that aims to scale up nutrition to save lives, prevent
      illness, and ensure healthy growth and development through improved infant young child
      feeding (IYCF) practices. The purpose of this study is to evaluate whether the Alive & Thrive
      intervention package, consisting of interpersonal communication, community mobilization
      activities, and radio campaign, can increase complementary feeding practices (minimum dietary
      diversity and minimum meal frequency) while sustaining exclusive breastfeeding rate among
      children less than two years of age. The impact evaluation uses a cluster-randomized design
      where 20 geographic clusters (woredas/districts) were randomized to two study arms - 10
      intervention areas and 10 comparison areas. Repeated cross-sectional baseline and endline
      surveys will be used to assess program impact.
    

Detailed description: 
      In Amhara, the median duration of exclusive breastfeeding (4.6 months) is the highest among
      all the other regions in the country, but complementary feeding indicators lag behind (2%
      minimum dietary diversity and 34% minimum meal frequency). As a result, A&T's program
      emphasis will be placed on increasing mothers' knowledge and skills to improve complementary
      feeding practices without compromising exclusive breastfeeding. Given the short duration of
      implementation, the goal is to show that it is possible to achieve behavior change related to
      IYCF through a multi-sector approach. The purpose of this study is to evaluate whether the
      Alive & Thrive intervention package, consisting of interpersonal communication, community
      mobilization activities, and radio campaign, can increase select complementary feeding
      practices (minimum dietary diversity and minimum meal frequency increased by 10 percentage
      points) while sustaining exclusive breastfeeding rate among children less than two years of
      age.

      A cluster randomized design with repeated cross-sectional surveys at baseline (2015) and
      endline (2017) is used to assess impact of the A&T interventions in three western zones of
      Amhara, Ethiopia. In the three zones, 20 woredas (districts) were randomly assigned as 10
      intervention and 10 comparison/control areas. A&T intervention areas are expected to receive
      intensive IYCF social and behavior change communication activities as well as exposure to a
      region-wide radio campaign. In accordance with program objectives, sample sizes for the
      household survey were estimated to detect changes in the three main impact indicators -
      sustained exclusive breastfeeding, improved minimum dietary diversity, and improved minimum
      meal frequency. The estimated household sample sizes are 400 children 0-5.9 months old for
      exclusive breastfeeding in the A&T intervention areas only and 1350 children 6-23.9 months
      old per study arm for complementary feeding practices, for a total sample size of 3100
      children 0-23.9 months of age. Infant feeding practices will be assessed using before- and
      after- intervention-comparison area group differences between the baseline survey
      (March-April 2015) and endline survey (March-April 2017). In addition, surveys of frontline
      workers will help document their awareness and knowledge about IYCF, training, supervision,
      and delivery of interventions to beneficiary households.
    

Intervention name(s): A&T community-based interventions; Mass media
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Interpersonal communication delivered by health workers and community volunteers at the health post and during home visits to:
- Increase mothers' knowledge about adequate child feeding practices
Interpersonal communication delivered by agricultural extension workers to:
- Increase fathers' knowledge about nutrition-sensitive agriculture and child feeding
Community mobilization activities to:
Raise awareness of child feeding practices among community members, and increase support to mothers (enhanced community conversations)
Increase mothers' knowledge about preparation of complementary foods (cooking demonstrations)
Raise awareness of adequate child feeding during fasting among family and community members (church sermons)
Enhanced training of government health and agricultural extension workers in infant and young child feeding to:
Improve their ability to provide timely and appropriate information and support to mothers and families; Radio campaign - radio drama series, spots, and jingles
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Child Nutrition; Breastfeeding; Complementary Feeding; Infant and Young Child Feeding; Social and Behavior Change Communication; Ethiopia