Differences in Complementary Feeding Practices within the Context of the WASH Benefits Randomized, Controlled Trial of Nutrition, Water, Sanitation, and Hygiene Interventions in Rural Kenya
Authors: Byrd Kendra , Williams Anne , Dentz Holly N. , Kiprotich Marion , Rao Gowthami , Arnold Charles D. , Null A. Clair , Dewey Kathryn G. , Stewart Christine P. 
Published: November 2023

Background and ObjectivePoor complementary feeding practices are associated with linear growth faltering in early childhood. The objective of this study was to evaluate the complementary feeding practices among households that participated in a randomized controlled trial of water, sanitation, hygiene, and nutrition interventions in rural Kenya.MethodsHouseholds were enrolled from rural, western Kenya and were cluster‐randomized to one of eight arms, including water (W); sanitation (S); hygiene (H); a combination of the three arms (WSH); nutrition (N); a combination of WSH+N; a passive control arm; and a double‐sized active control arm. With each intervention, families participated in behavior change communication (BCC) programs that complemented the hardware they received, and which were adapted through formative research. In the N and WSH+N arms, households received messages on breastfeeding and complementary feeding practices, in addition to lipid‐based nutrient supplements (LNS) for infants 6–24 months of age. These messages were delivered monthly by health promoters, who were selected from the local villages, and trained by study staff on the BCC messaging. After one year of the intervention, trained enumerators surveyed the mothers to ascertain complementary feeding practices, including dietary diversity, feeding frequency, and infant dietary intake. For each outcome, we collapsed the non‐nutrition and nutrition arms into two groups, and analyzed pairwise comparisons using a mixed log binomial model, with robust standard errors to account for the design effect.ResultsA total of 3,526 breastfeeding mothers were surveyed, and their infants were between 7–14 months of age. The mean (SD) number of food groups the infants consumed in the past 24 hours was 3.6 (1.1) groups and the infants were fed a mean(SD) of 3.4(1.6) times/day. We found that 60.4% of infants achieved the criteria for minimum dietary diversity (MDD, ≥4 food groups), 73.7% achieved the minimum meal frequency (MMF, ≥2 feeds for 6–8 mo olds or ≥3 feeds for 9–23 mo olds), while 46.7% reached the criteria for a minimally adequate diet (MAD). There was a higher prevalence of infants in the nutrition arms achieving MDD (63.6% versus 59.4% in the non‐nutrition arms), though this difference was only marginally significant (PR: 1.22, 95% CI: 0.99 – 1.49). There were no differences in the prevalence of those who met the MMF or MAD criteria between groups.ConclusionIn rural Kenya, households that received nutrition messages along with LNS were only modestly more likely to achieve MDD compared to households in the non‐nutrition arms. Behavior change communication interventions alone may not be effective at improving dietary diversity without addressing other factors, such as resource constraints.Support or Funding InformationFunding source: Funded by a grant to UC Berkeley from the Bill and Melinda Gates Foundation with additional support from the National Institutes of Health.