Differences in Child Feeding and Handwashing Practices within the Context of a Randomized Controlled Trial of Nutrition, Water, Sanitation, and Hygiene Interventions among Low‐income Bangladeshi Mothers
Authors: Jannat Kaniz , Luby Stephen P , Unicomb Leanne , Das Kishor Kumar , Leontsini Elli , Rahman Mahbubur , Winch Peter , Stewart Christine 
Published: November 2023

Background and objectives

Inappropriate complementary feeding (CF) contributes to linear growth faltering in early childhood. Complementary foods are frequently contaminated and thus are a major cause of diarrhea and malnutrition in children. The objective of the study is to assess the CF practices and evaluation of hand hygiene behavior among the mothers that participated in a randomized controlled trial (RCT) of nutrition (N), water (W), sanitation (S) and hygiene (H) interventions.

Methods

WASH Benefits is an ongoing RCT measuring the health impact of low‐cost nutrition and WSH interventions. We enrolled households (HH) from rural areas of four northern districts in Bangladesh. HH were randomized to control (C) and single/combined nutrition and WSH interventions. N and WSH+N groups received messages on breastfeeding and CF as well as lipid based nutrient supplements for infants aged 6–24 months. Information on food groups was conveyed to the mothers using illustrative flip charts twice a month. Mothers were encouraged to feed family foods to their children. Cue cards were delivered to the HH as a reminder. H, WSH and WSH+N groups received messages to wash hands with soap at three key times though not before child feeding. These groups also received two handwashing stations that include water reservoir and soap. Approximately 1.5 years after initiation of the intervention, fieldworkers surveyed 4718 mothers and assessed handwashing stations. Minimum dietary diversity (MDD) and minimum meal frequency (MMF) were calculated using infant and young child feeding guidelines, WHO. We used log‐binomial regression models to estimate proportion ratios (PR) with clustered sandwich estimators to adjust for clustering.

Results

The children aged 6–23 month who met the MDD score were more common in N intervention groups (N: 80%; WSH+N: 81%) compared the other groups (C: 46%; W: 52%; S: 50%; H: 52%; WSH: 51%; PR=1.6, 95% CI 1.5–1.7 for N vs. non‐N groups). Children were more likely to meet MMF in the N groups (N: 92%; WSH+N 93%) than the other groups (C: 83%; W: 84%; S: 86%; H: 84%; WSH: 86%; PR= 1.1, 95%CI= 1.07–1.13). Reported HW with soap before child feeding was more common in the N groups (N: 54%; WSH+N 47%) compared to other groups (C: 19%; W: 26%; S: 28%; H: 36%; WSH: 40%; PR= 1.8, 95%CI= 1.6–2). Presence of soap and water at the primary HW station near cooking area was also more common in the N groups (N: 50%; WSH+N: 97%) compared to other groups (C: 28%; W: 24%; S: 36%; H: 98%; WSH: 98%; PR= 1.1, 95%CI= 1.02–1.12).

Conclusions

Households who received nutrition messages were significantly more likely to meet minimum dietary diversity and minimum meal frequency guidelines compared to other groups. Even though handwashing with soap before child feeding was not specifically promoted in any study groups, it was more common among the nutrition groups.

Support or Funding Information

BMGF.