Background Infant and young child feeding (IYCF) practices are important for child survival and healthy growth, but IYCF practices remain suboptimal in Nigeria. The objective of this study was to measure the impact of Alive & Thrive’s IYCF social and behavior change communication intervention on early initiation of breastfeeding, exclusive breastfeeding, and minimum dietary diversity in Kaduna and Lagos States. Methods Local government areas were randomly allocated to intervention or comparison. Cross-sectional surveys of households with children aged 0–23 months were conducted [N = 6,266 baseline (2017), N = 7,320 endline (2020)]. Logistic regression was used to calculate difference-in-differences estimates (DDEs) of impact on IYCF practices and to assess within group changes from baseline to endline. Associations between intervention exposures and IYCF practices were tested in both study groups combined. Results In Kaduna, a positive differential effect of the intervention was found for exclusive breastfeeding (adjusted DDE 8.9 pp, P<0.099). Increases in both study groups from baseline to endline were observed in Kaduna for early initiation of breastfeeding (intervention 12.2 pp, P = 0.010; comparison 6.4 pp, P = 0.118) and minimum dietary diversity (intervention 20.0 pp, P<0.001; comparison 19.7 pp, P<0.001), which eliminated differential effects. In Lagos, no differential intervention impacts were found on IYCF practices because changes in early initiation of breastfeeding from baseline to endline were small in both study groups and increases in both study groups from baseline to endline were observed for exclusive breastfeeding (intervention 8.9 pp, P = 0.05; comparison 6.6 pp, P<0.001) and minimum dietary diversity (intervention 18.9 pp, P<0.001; comparison 24.3 pp, P<0.001). Odds of all three IYCF practices increased with exposure to facility-based interpersonal communication in both states and with community mobilization or mass media exposure in Kaduna. Conclusions This evaluation found weak impacts of the Alive & Thrive intervention on IYCF practices in the difference-in-differences analysis because of suspected intervention spillover to the comparison group. Substantial within group increases in IYCF practices from baseline to endline are likely attributable to the intervention, which was the major IYCF promotion activity in both states. This is supported by the association between intervention exposures and IYCF practices. Trial registration The study was registered with clinicaltrials.gov (NCT02975063).
Objectives The objective of this study was to evaluate the impact of Alive & Thrive Nigeria's infant and young child feeding (IYCF) behavior change communication (BCC) activities, including interpersonal communication in health facilities, community mobilization, and mass media, on early initiation of breastfeeding, exclusive breastfeeding, and minimum dietary diversity. Methods Local government areas in Kaduna and Lagos States were randomized to intervention or comparison and cross-sectional surveys of households with children aged 0–23 months [N = 6,266 baseline (2017), N = 7,320 endline (2020)] were conducted. Difference-in-differences and post-hoc baseline-endline models were used to measure intervention impacts. Results Difference-in-differences models showed no significant differences between the intervention and comparison areas in early initiation of breastfeeding (both states), exclusive breastfeeding (Kaduna), or minimum dietary diversity (both states). In Lagos, an 11.5 percentage point increase in exclusive breastfeeding in the intervention compared with the comparison area trended toward significance (P = 0.08). At endline, exposure to interpersonal communication, community mobilization, and mass media did not differ by study area in either state. Given the overall lack of differences in intervention exposure by study area, post-hoc baseline-endline analyses were performed with the study areas combined and increases were detected in early initiation of breastfeeding (Kaduna 40% to 46%, P = 0.05), exclusive breastfeeding (Kaduna 25% to 43%, P < 0.001), and minimum dietary diversity (Kaduna 20% to 41%, P < 0.001; Lagos 37% to 58%, P < 0.001). Conclusions This evaluation found minimal impacts of the Alive & Thrive intervention on IYCF practices in the difference-in-differences analysis because of intervention spillover to the comparison area. Increases in IYCF practices from baseline to endline were substantial and are likely attributable to the intervention, which was the major IYCF promotion activity in both states. Funding Sources This research was funded by the Alive & Thrive initiative, managed by FHI Solutions, and currently funded by the Bill & Melinda Gates Foundation, Irish Aid, the Tanoto Foundation, UNICEF, and the World Bank.
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