Effectiveness of a nutrition education intervention to improve complementary feeding practices : a randomized controlled trial in Cambodia
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Main causes for child undernutrition are a diet poor in quality and quantity, feeding practices, and hygiene. In particular during the first two years of life, the so called window of opportunity , the timeliness of the introduction, quality, quantity, and appropriateness of complementary food are crucial to ensure adequate growth and motor, and mental development. Chronic malnutrition leads to stunted growth and increases child morbidity and mortality. Young child feeding practices are influenced by a multitude of factors such as maternal health and education, household wealth and food security status. Often a lack of knowledge on age-appropriate infant and young child feeding practices among caregivers is one of the main contributors. Community-based nutrition education interventions are potential solutions to improve caregiver s complementary feeding practices by increasing knowledge of age-appropriate diets as well as caring and feeding practices. Evidence on best feasible practices to date remains rare. As causes are multifaceted nutrition-sensitive interventions and programs have shown enormous potential to enhance the scale and effectiveness of nutrition-specific interventions.From 2012 to 2014, a cluster randomized trial was rolled out in 2 provinces in Cambodia in the context of an agriculture and nutrition project of the Food and Agriculture Organization (FAO) of the United Nations. The cross-sectional baseline was carried out in 16 pre-selected communes in 2012. Restricted randomization selected the communes into intervention (nutrition education and agriculture intervention) and comparison (agriculture intervention only). The impact survey was conducted as census in all FAO project villages in 2014. Caregivers of children aged 0-23 months were interviewed using standardized questions on socio-economic status and dietary diversity (24-hr recall). Anthropometric measurements were taken. Minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and child dietary diversity was calculated as food group score (min-max: 0-7) for children aged 6-23 months following WHO guideline. A child feeding index (CFI; 0-10) was created for children aged 6-23 months consisting of five components: breastfeeding, use of bottle, dietary diversity, food frequency and meal frequency which were adjusted for three age groups: 6-8, 9-11 and 12-23 months. In a first step associations between height-for-age Z-scores (HAZ) and WHO indicators (MDD, MMF, MAD) or CFI were explored with baseline data. In a second step a difference-in-differences (DiD) model was applied testing community effects of the intervention.At baseline, 803 children aged 6-23 months were included in the analysis. None of the WHO IYCF indicators was associated with HAZ, whereas CFI showed significant association with HAZ (P< 0.01). The association between higher CFI scores and HAZ became weaker as age increased. Two years after the baseline survey, after one year of nutrition education, 62% of the intervention households (N= 524) reported to have participated in the nutrition education. A total of 1,664 datasets were used for analysis consisting of 743 and 921 caregiver-child-pairs from baseline and impact survey, respectively. Children s age ranged from 6- 23 months with a mean (±SD) age of 13.5 (±5.2) months at baseline and 14.2 (±5.2) months at impact. Overall, children s diets improved. Estimated mean child dietary diversity was significantly different at impact between comparison and intervention (3.6 and 3.9, respectively). In particular the consumption of beta-carotene rich foods and other fruits and vegetables increased. No treatment effects on HAZ could be shown.This thesis shows that when linking infant and young child feeding practices to child growth, it is necessary to include more than one indicator into the analysis. Furthermore, it could be shown that participation in a nutrition education program led to increased child dietary diversity whereas participation in an agriculture intervention only did not show any improvements. The results highlight the potential of nutrition-sensitive agriculture interventions including nutrition-specific actions to address causes of child malnutrition in developing countries. For future research it is recommended to focus on the assessment of existing programs and available best practices. Efforts need to be directed towards a better understanding of the local context and needs to contribute to alleviation of malnutrition in a sustainable way.Verknüpfung zu Publikationen oder weiteren Datensätzen
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Giessen : VVB Laufersweiler Verlag