Integrated Education Intervention to Improve Infant and Young Child Nutrition and Growth in Ghana
Condition: Improving Young Child Nutrition
Study type: Interventional

Summary: 
      In Ghana the level of malnutrition is high among children below five years of age,
      particularly in rural areas. The objective of the study was to investigate the effects of an
      education intervention aimed at addressing poor complementary feeding (CF) practices on the
      food intakes and growth of young children in the Upper Manya Krobo district of Ghana.

      Interviews and focus group discussions involving community health and agricultural workers,
      as well as caregivers of children 6-24 months old were conducted to investigate the
      facilitators and challenges to optimal CF practices and education on CF. The trials of
      improved practices (TIPs) method was used to test the feasibility and acceptability of
      potential education messages among mothers of young children (6-24 months) living in the
      study area. Child welfare clinic centers in the area were randomly assigned to one of three
      groups which were control, nutrition education and integrated education. Mothers of children
      6-24 months in the integrated education group received monthly nutrition education from
      community health volunteers and agricultural education from agricultural extension agents for
      six months in addition to standard monthly child growth monitoring services from community
      health nurses. Mothers in the nutrition education group received monthly nutrition education
      from community health volunteers for six months in addition to standard care. Mothers of 6-24
      months in the control group received only the standard monthly child monitoring services. The
      effects of the educational intervention on maternal knowledge on optimal complementary
      feeding, as well as food intakes and growth of young children were determined among 367
      mother-child dyads over a period of at least six months. The study hypothesised that mothers
      receiving the education would have improved knowledge on good complementary feeding practices
      compared to those in the control group. The study also hypothesised that young children in
      the integrated education would have better nutrient intakes and growth compared those in the
      nutrition education and control groups, and those in the nutrition education group would have
      better nutrient intakes and growth than the children in the control group.

      From the interviews and focus group discussions, reported initiation of CF was satisfactory,
      while other reported practices such as the addition of animal source foods, vegetables and
      fruits to young children's diet were found to be sub-optimal. Poverty and maternal time
      constraints were identified as the main challenges of optimal complementary feeding, while
      farming was seen as a facilitator. Lack of education materials, language barrier, maternal
      time constraints and lack of in-service training for health workers were the main challenges
      to education on complementary feeding. From the TIPS study, mothers expressed their
      willingness to improve the diets of their 6-24 months old children by adding or increasing
      the amount of animal source foods, dark-green leafy vegetables and fruits, as well as
      increasing feeding frequency daily. However, availability and affordability of protein-rich
      foods like animal source foods, groundnut paste and soya beans powder was a challenge for
      some mothers.

      The intervention did not lead to a significant improvement in maternal knowledge on
      complementary feeding practices. However, it showed a tendency to reverse a general
      decreasing trend in knowledge among mothers on appropriate complementary feeding practices in
      the study area. Significantly more children in the integrated education group consumed animal
      source foods compared those in the other two groups when compared at nine months after
      baseline. However, the intervention did not improve the general nutrient intakes and growth
      of the young children in the study area.
    


Intervention name(s): nutrition and agricultural education; nutrition education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Mothers of children aged 6-24 months received monthly nutrition education delivered by community health volunteers and agricultural education delivered by agricultural extension agents, in addition to standard monthly child welfare services delivered by Ghana Health Service; Mothers of children aged 6-24 months received monthly nutrition education delivered by community health volunteers in addition to standard child growth monitoring services provided by the Ghana Health Service.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: complementary feeding; mothers; 6-24 months children; community health volunteers; nutrition education; agricultural education