Complementary feeding practices among rural Bangladeshi mothers: Results from WASH Benefits study

Abstract

Inappropriate complementary feeding contributes to linear growth faltering in early childhood. Behaviour change interventions have been effective at improving practice, but few studies have investigated the effects of multicomponent integrated interventions. We conducted a cluster-randomized controlled trial in rural Bangladesh in which geographic clusters were randomized into seven arms: water treatment (W), sanitation (S), handwashing (H), water, sanitation, and handwashing (WSH), improved nutrition with infant and young child feeding messages and lipid-based nutrient supplementation for 6- to 24-month olds (N), N+WSH, and control. The objective of this paper was to examine the independent and combined effects of interventions on indicators of complementary feeding. Approximately 1 and 2 years after initiation of the intervention, research assistants surveyed mothers about infant feeding practices. Complementary feeding was examined using the World Health Organization indicators of infant and young child feeding practices. We used Poisson regression models to estimate prevalence ratios and linear regression models for prevalence differences with clustered sandwich estimators to adjust for clustering. A total of 4,718 households from 720 clusters were surveyed at year 1 and 4,667 at year 2. The children in the nutrition arms had a higher prevalence of meeting the minimum dietary diversity score compared with controls (year 1: N: 66.4%; N+WSH: 65.0% vs. C:32.4%; year 2: N: 91.5%; N+WSH: 91.6% vs. C:77.7%). Children in the nutrition arms received diverse food earlier than the children in control arm. In addition, the average consumption of lipid-based nutrient supplementation was >90% in each follow-up. Nutrition-specific interventions could be integrated with nutrition-sensitive interventions such as WSH without compromising the uptake of the nutrition intervention.

A behaviour change intervention with lipid‐based nutrient supplements had little impact on young child feeding indicators in rural Kenya

“…We saw only a modest effect on MDD at Year 1 and no effect at Year 2. In contrast, the WASH Benefits trial in Bangladesh showed an improvement in complementary feeding practices after the community health workers visited twice monthly (Jannat et al, 2018).…”

“…We saw only a modest effect on MDD at Year 1 and no effect at Year 2. In contrast, the WASH Benefits trial in Bangladesh showed an improvement in complementary feeding practices after the community health workers visited twice monthly (Jannat et al, ). Additionally, other BCC programmes that have been effective at improving complementary feeding outcomes have had a mass media component, which our programme lacked (Sanghvi et al, ).…”

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention–A Randomised before and after Trial

“…There may be concerns that the integration of too many health and hygiene messages within specific caregiver groups could be overwhelming for both facilitators and participants. However, the call for an improved integration of services, as well as evidence from recent studies [53], demonstrates that such integration is an effective route for improving hygiene practices in the lowest quintile of caregivers by education.…”

Snack food consumption among Bangladeshi children, supplementary data from a large RCT

“…We previously reported that the nutrition intervention, which focused on the timely introduction of diverse complementary foods, resulted in a higher dietary diversity score at both time points (Jannat et al, 2018) and high adherence to lipid‐based nutrient supplementation recommendations (Luby et al, 2018). The present data suggest that parents prioritized feeding the promoted nutritious foods or lipid‐based nutrient supplements over commercially available sweet, salty, or packaged snack foods to their children.…”

“…This model was used to assess the association among children from the nutrition or nonnutrition arms and controls separately. We examined that the association between snack food consumption and dietary diversity in the nutrition arm and other arms as dietary diversity was similar among children from control and nonnutrition arms (Jannat et al, 2018). Food insecurity was measured using WHO Household Food Insecurity Access Scale (Coates, Swindale, & Bilinsky, 2007).…”