An integrated infant and young child feeding and small‐quantity lipid‐based nutrient supplementation programme in the Democratic Republic of Congo is associated with improvements in breastfeeding and handwashing behaviours but not dietary diversity

Abstract

Integrating small‐quantity lipid‐based nutrient supplements (SQ‐LNS) into infant and young child feeding (IYCF) programmes can increase consumption of essential nutrients among children in vulnerable populations; however, few studies have assessed the impact of integrated IYCF–SQ‐LNS programmes on IYCF practices. A 2‐year, enhanced IYCF intervention targeting pregnant women and infants (0–12 months) was implemented in a health zone in the Democratic Republic of Congo (DRC). The enhanced IYCF intervention included community‐ and facility‐based counselling for mothers on handwashing, SQ‐LNS, and IYCF practices, plus monthly SQ‐LNS distributions for children 6–12 months; a control zone received the national IYCF programme (facility‐based IYCF counselling with no SQ‐LNS distributions). Cross‐sectional preintervention and postintervention surveys ( n = 650 and 638 in intervention and control areas at baseline; n = 654 and 653 in each area at endline, respectively) were conducted in mothers of children 6–18 months representative of both zones. Difference in differences (DiD) analyses used mixed linear regression models. There were significantly greater increases in the proportion of mothers in the intervention (vs. control) zone who reported: initiating breastfeeding within 1 hr of birth (Adj. DiD [95% CI]: +56.4% [49.3, 63.4], P < 0.001), waiting until 6 months to introduce water (+66.9% [60.6, 73.2], P < 0.001) and complementary foods (+56.4% [49.3, 63.4], P < 0.001), feeding the minimum meal frequency the previous day (+9.2% [2.7, 15.7], P = 0.005); feeding the child in a separate bowl (+9.7% [2.2, 17.2], P = 0.01); awareness of anaemia (+16.9% [10.4, 23.3], P < 0.001); owning soap (+14.9% [8.3, 21.5], P < 0.001); and washing hands after defecating and before cooking and feeding the child the previous day (+10.5% [5.8, 15.2], +12.5% [9.3, 15.6] and +15.0% [11.2, 18.8], respectively, P < 0.001 for all). The enhanced IYCF intervention in the DRC was associated with an improvement in several important IYCF practices but was not associated with a change in dietary diversity (minimum dietary diversity and minimum acceptable diet remained below 10% in both zones without significant differences between zones). The provision of fortified complementary foods, such as SQ‐LNS, may be an important source of micronutrients and macronutrients for young children in areas with high rates of poverty and limited access to diverse foods. Future research should verify the potential of integrated IYCF–SQ‐LNS to improve IYCF practices, and ultimately children's nutritional status.

Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program)

“…This is consistent with findings from Ethiopia that found that household production of fruits and vegetables was associated with child MDD (Kuche et al, 2020 ). A recently published intervention study in Katanga, DRC found that small quantity lipid‐based nutrient supplements increased gross motor and communication ASQ domains (Addo et al, 2020 ), however, no improvement in dietary diversity was observed (Locks et al, 2019 ). Lipid‐based nutrient supplements can be a costly and challenging programmatic approach to sustain over time at scale, and may disrupt existing positive child feeding practices (e.g., local diverse diet) (Dewey & Arimond, 2012 ; Flax et al, 2010 ).…”

Combined infant and young child feeding with small-quantity lipid-based nutrient supplementation is associated with a reduction in anemia but no changes in anthropometric status of young children from Katanga Province of the Democratic Republic of Congo: a quasi-experimental effectiveness study

“…Given that per protocol analyses showed a positive impact in the DRC, this suggests that, on average, all children might not have received SQ-LNS monthly or the other components [e.g., wash, sanitation, and hygiene (WASH), counseling messages, or increased contacts with health service] and hence it is possible that, with improved program fidelity, the IYCF–SQ-LNS package may demonstrate greater effectiveness and impact at scale. Despite improvements in certain aspects of IYCF, there were very few changes in dietary indicators, such as dietary diversity ( 27 ), implying that even if products like SQ-LNS are available, efforts to improve the quality of locally available complementary foods, increasing dietary diversity, and food security should remain a priority.…”

“…While both the intervention HZ and the comparison HZ received counseling, the intervention HZ included outreach counseling by CHWs on IYCF and SQ-LNS, in addition to facility-based counseling, while the comparison HZ received only facility-based counseling and no SQ-LNS distribution or counseling. A full description of the enhanced IYCF–SQ-LNS program is detailed elsewhere ( 27 ). Informed consent was obtained from each mother/caregiver, and for illiterate participants it was administered in the presence of a literate adult household member.…”

“…The enhanced IYCF program had comprehensive counseling and educational components that targeted all mothers and their children (up to 12 mo of age) and pregnant women in the intervention catchment area, but not the comparison HZ, as detailed elsewhere ( 27 ). This was achieved by developing information, education, and communication materials and messages and tailored key messages, which were reinforced through various channels in the intervention site.…”

“…We evaluated the potential dose–response effect of the SQ-LNS among children 8 to 13 mo old in the intervention HZ who were eligible to receive ≥3 monthly SQ-LNS distributions (3 × 28 sachets) and eligible to receive LNS within the last month. This 8–13-mo age group was selected because SQ-LNS were distributed during routine monthly health facility visits; however, timely introduction of solid foods/complementary feeding at 6 mo in the villages in both HZs was low, ∼27% ( 27 ). Children who were only 6 or 7 mo old would have had no or limited time to consume SQ-LNS sachets as they would have received only 1 or 2 batch distributions at maximum, whereas children aged 13 mo would have recently finished SQ-LNS intake and have had a high potential exposure to SQ-LNS over the prior 6 mo.…”