Evaluation of a Social Network for Improved Child Nutrition
Authors: Fiorella Kathryn J , Moore Megan , Wilson‐Anumudu Folasade , Argent Autumn , Gavenus Erika , Milner Erin M , Omollo Dan , Fernald Lia 
Published: November 2023

Research efforts have identified the power of social networks to influence health outcomes and their role in providing psychosocial, emotional, and material resources for maintaining good health practices. We evaluate an intervention designed to treat social networks affected by maternal and child malnutrition and engage not only mothers but also fathers, friends, and grandparents. The intervention included 6 facilitated sessions with sustained support for the subsequent year. Facilitators led groups (e.g. dramas, cooking demo, etc) in partnership with community health volunteers in topics of breastfeeding, infant and young child feeding, and dietary diversity. Our approach aims to foster social support to improve nutrition knowledge and infant and young child feeding practices.We use a mixed methods approach: 1) controlled post‐intervention assessment of nutrition knowledge among participants (CHVs n=24; community n=43) and controls (CHVs n=62; community n=149), 2) a case‐control study of child feeding assessed with a 24 Hour Recall (participants n=48; controls n=211) and 3) focus groups (7).Community members and CHVs who participated in and led nutrition social‐network groups had higher nutrition knowledge overall (community health volunteers: 10.6 to 9.4, p < 0.001; community member: 9.8 to 9.0, p<0.01; scale 1–12) and of breastfeeding practices (CHV: 5.4 to 4.4, p < 0.0001; community: 4.9 to 3.8, p<0.0001; scale 1–6) when compared to those who did not participate. Our focus group discussions affirm these findings and emphasize the role of caregiver confidence in feeding young children and ideas of nutritional balance when introducing complementary foods.There was an increase in the percent of intervention children who met indicators of minimum dietary diversity (10% to 40%, p < 0.01) and minimum acceptable diet (8% to 31%, p<0.01) immediately after the intervention, but both returned to baseline six months later. Control children also had an increase in dietary diversity (20% to 33%, p<0.01), and subsequent return to baseline. Strong seasonality effects are evident at 6‐months. Focus group findings underscored the challenges of carrying out infant and young child feeding recommendations and the importance of multi‐dimensional support for caregivers and community collaboration to meet nutritional goals and exercise knowledge.At two years, gains in nutrition knowledge, community support, and engagement endured; however, initial gains in young child feeding practices were not maintained at 6 months. While social network groups may be a useful platform for deepening knowledge and engagement, the intervention needs to be enhanced further to support nutrition outcomes. The relatively short duration of the program, challenges of engaging men, and substantial seasonality of food insecurity might particularly shape program outcomes. Seasonality of dietary diversity was evident in both control and intervention groups and this intervention might perform best in relatively food secure contexts or when seasonality is less pronounced. Engagement social network groups to improve access to diverse foods through durable changes to production or resilience to shocks/seasonality are potential avenues for intervention improvement.Support or Funding InformationNutrition Embedding Evaluation Program, PATH & DFID, NSF‐GEO grant CNH115057, Atkinson Center, NSF DDRI (KJF), USAID Global Innovation Fellowships (AA), UC Berkeley Center for Global Public Health (FW)