Effectiveness of Behavior Change Communication in Improving Feeding Practices, Nutritional and Health Status of Infants
Condition: Feeding Behavior; Nutritional Status; Morbidity
Study type: Interventional

Summary: 
      Child under nutrition is a major risk factor for ill health and mortality, contributes
      substantially to the burden of disease in low-income and middle-income countries and is
      associated with close to half of all child deaths. The prevalence of both underweight and
      stunting is highest in Africa and South-Central Asia. Ethiopia is one of the poorest
      countries in Sub- Saharan Africa, and child malnutrition is a serious public health problem
      where the rates for stunting (40%), underweight (25%) and wasting (9%) among children under 5
      years are among the highest in the world.

      Globally, about 40% of child mortality less than two years is associated with inappropriate
      feeding practices. Optimal breastfeeding and appropriate complementary feeding could prevent
      13% and 6% under-five mortality, respectively. Over two third of malnutrition is associated
      with inappropriate feeding practices during the first year of life.

      The first two years of life provides a critical window of opportunity for ensuring
      appropriate growth and development of children from generation to generation through optimal
      feeding. Hence, the objective of this study to evaluate the effectiveness of behavior change
      communication on optimal complementary feeding through community level actors in improving
      feeding practice, health and nutritional status of infants.

      A cluster-randomized controlled trial which was conducted in West Gojjam Zone, Northwest
      Ethiopia from May 9, 2016 to October, 2017. Behavior change communication on complementary
      feeding was conducted in the intervention kebeles/villages for 8 months. A validated
      interviewer administered structured questionnaire was used for collecting information on the
      study subjects both at the baseline and after intervention. Data will be checked, coded and
      double entered using EPI info and exported to SPSS version 21 for statistical analysis.

      The output of the study findings could be useful for health and nutrition policy makers and
      other concerned bodies in decision making and to design effective intervention strategies to
      improve feeding practices thus mitigating child malnutrition and improving their health and
      growth. The total budget needed to conduct the study is 7,000 US dollar.
    

Detailed description: 
      Globally, about 40% of death children less than two years is associated with inappropriate
      feeding practices. Optimal breastfeeding and appropriate complementary feeding could prevent
      13% and 6% under-five mortality, respectively. Over two third of malnutrition is associated
      with inappropriate feeding practices during the first year of life.

      Every day, 3000-4000 infants die in the developing world from diarrhea and acute respiratory
      infections because they are given inadequate amounts of breast milk. More than 10 million
      children die each year in sub- Saharan Africa and South Asia. A major contributor to their
      deaths is poor breastfeeding practice. The risk of death from diarrhea of partially breastfed
      infants 0 - 6 months of age was 8.6 times the risk for exclusively breastfed children.

      Infant and young feeding practices for infant and young children worldwide are not optimal.
      It is only 34.8% of infants are exclusively breastfed worldwide. Complementary foods are
      often introduced too early or too late and are often nutritionally inadequate or unsafe. Only
      about 39% of infants in the developing countries, 25% in Africa are exclusively breastfed for
      the first six months and 6% of infants in developing countries are never breastfed.

      A wide range of harmful infant and young child feeding practices were documented in Ethiopia.
      According to EDHS of 2011, 52% of infants started breastfeeding within one hour of birth and
      exclusive breastfeeding during the first six months with the 4.2 months mean duration of
      exclusive breastfeeding. About half (49%) of children aged 6-8 months consumed solid,
      semi-solid, or soft foods and 5% of children were fed minimum dietary diversity and 4% of
      children fed minimum meal frequency per day while 96% of children continued breastfeeding at
      one year, and 82% continued at 2 year. Only 4% of children 6 - 23 months living with their
      mothers are fed in accordance with infant and young child feeding practices and 66% children
      under the age of two receive age-appropriate breastfeeding. Overall, nearly three children in
      every ten (27%) are given prelacteal feeds within the first three days of life.

      In Amhara region, 38% of infants started breastfeeding within one hour of birth while only 2%
      and 34% of children 6-24 months were fed according to the minimum standards with respect to
      food diversity (four or more food groups) and meal frequency.

      Sub-optimal infant and young child feeding practices are associated with caretakers' poor
      knowledge, lack of information and being restricted by traditional beliefs. It is essential
      to give caregivers necessary knowledge and information to alter their inappropriate feeding
      behaviors. Promotion of appropriate feeding practices, therefore, is fundamentally important
      in reducing child malnutrition and mortality and, thus, for achieving MDG 1. In order to
      sustain the gains made by promoting exclusive breastfeeding for the first six months of life,
      interventions need to extend into the second half of infancy and beyond. This could be
      ensured by enabling caregivers to appropriately feed their children with safe and adequate
      complementary foods while maintaining frequent breastfeeding.

      Several efforts to improve the feeding status of the infant and young children have been
      carried out at different times. The Ethiopian government developed the infant and young child
      feeding guideline in 2004 following WHO recommendations of global strategy for feeding
      infants and young children for proper nutrition & health. Community based nutrition program
      was also designed to build upon the HEP packages and implemented in all agrarian regions of
      Ethiopia. However, these efforts have failed to bring about substantive and sustainable
      changes leading to improvement of infant and young child feeding practices since efforts
      (nutrition actions) were not based on the evidence on existing feeding practices and what
      works and what does not. Moreover, the health extension workers were not effectively
      networked with the community volunteers, work load for health extension workers and lack of
      training and supervision outcomes could factor their effects on the feeding practices.

      As a result, the problem of stunting has remained pervasively high in the country. The
      government has designed an accelerated stunting reduction program under the revised national
      nutrition program. Moreover the Federal Ministry of Health has made reduction of child
      malnutrition in Ethiopia a priority flagship program under the commitment to the Seqota
      declaration, which states zero level hunger among under two children by 2030. Therefore, the
      aim of this study is to evaluate the effectiveness of behavior change communication on
      optimal complementary feeding through community level actors in improving feeding practice,
      nutrition and health status of infants.
    

Intervention name(s): Behavior change communication
Intervention type(s): Behavioral
Intervention description(s): Behavior change communication about optimal complementary feeding
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention