Nutrition Behaviour Change Communication improves caregivers Infant and Young Child Feeding knowledge, practices, purchase and feeding infants Protein Micronutrient Powders
Authors: Annan Reginald A. , Attu Samuel Selorm , Tandoh Nancy , Timpo Olivia , Ankwah Yaa Konadu , Ahiavih Francisca Esenam , Okonogi Satoru , Sakurai Takeshi 
Published: May 2024

Background
The early years of infants and young children are pivotal for their optimal health and development as adults are heavily reliant on appropriate feeding and adequate nutrition. Although maternal infant feeding practices play a crucial role in ensuring these aspects, studies exploring the impact of maternal IYCF knowledge and infant feeding practices across various contexts have been lacking. This study sought to evaluate the impact of NBCC intervention on caregivers' knowledge of IYCF guidelines, and how improved knowledge affected caregivers' behaviour regarding the purchase and feeding of nutritious complementary foods to their infants and young children.
Methods
Conducted in the Asokore Mampong and Bosomtwe Municipalities of the Ashanti Region in Ghana, West Africa, the study recruited 1500 mother-infants (aged 6–23 months) pairs from Child Welfare Clinics (CWCs). Specially trained health professionals who worked in these CWCs delivered weekly nutrition education, counselling, and monthly cooking demonstrations over six months. These interventions targeted the enhancement of caregivers' understanding and practical utilization of locally available food ingredients and nutritious Protein Micronutrient Powders (Koko plus) for complementary feeding. A structured questionnaire, based on WHO guiding principles for complementary feeding, was administered before and after the interventions to gauge changes in IYCF knowledge and practices among participants.
Results
The average age of the caregivers was 29.0 ± 6.52 years. Close to three-quarters (73.2%) had basic school or less and about two-thirds (64.4%) were unemployed. NBCC interventions led to marked improvements in IYCF knowledge. Caregivers demonstrated poor baseline knowledge, with only 20% answering correctly on exclusive breastfeeding duration and 3.5% on complementary feeding frequency. Post intervention, there was a substantial increase in correct responses, reaching 69.0% for exclusive breastfeeding duration and 98.5% for complementary feeding frequency. Pre-intervention, over 8 in 10 (82.5%) caregivers exhibited inadequate overall IYCF knowledge on 12 questions, whereas post-intervention, over two-thirds (68.4%) of caregivers demonstrated adequate knowledge. NBCC intervention notably improved caregivers' knowledge of PMP, with an increase from 44.8% pre-intervention to 93.8% post-intervention. Correspondingly, the proportion of caregivers purchasing PMP increased from 20–86.6% while utilization (feeding infants) improved from 19.4% to nearly 90%. The quantity and expenditure on PMP also substantial increased post-intervention, with caregivers purchasing significantly more sachets (from 10.07 to 16.75) and spending more money (from 59.48 to 68.83 Ghana Cedis) PMP purchase. Linear regression analysis indicated a positive relationship between expenditure and the quantity of complementary foods purchased at the endline.
Conclusion
Consensus exists that educational interventions positively influence caregivers' knowledge, leading to better IYCF practices and our study findings confirm this, improving complementary feeding practices. These enhanced feeding practices could potentially improve infant nutrition and health outcomes. Tailored, context-specific interventions and continuous support are crucial for sustained behaviour change and positive child health and nutrition outcomes.