Exposure to Large-Scale Social and Behavior Change Communication Interventions Is Associated with Improvements in Infant and Young Child Feeding Practices in Ethiopia

Abstract

Optimal breastfeeding (BF) practices in Ethiopia are far below the government’s targets, and complementary feeding practices are poor. The Alive & Thrive initiative aimed to improve infant and young child feeding (IYCF) practices through large-scale implementation of social and behavior change communication interventions in four regions of Ethiopia. The study assessed the effects of the interventions on IYCF practices and anthropometry over time in two regions–Southern Nations, Nationalities and Peoples Region and Tigray. A pre- and post-intervention adequacy evaluation design was used; repeated cross-sectional surveys of households with children aged 0–23.9 mo (n = 1481 and n = 1494) and with children aged 24–59.9 mo (n = 1481 and n = 1475) were conducted at baseline (2010) and endline (2014), respectively. Differences in outcomes over time were estimated using regression models, accounting for clustering and covariates. Plausibility analyses included tracing recall of key messages and promoted foods and dose-response analyses. We observed improvements in most WHO-recommended IYCF indicators. Early BF initiation and exclusive BF increased by 13.7 and 9.4 percentage points (pp), respectively. Differences for timely introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich foods were 22.2, 3.3, 26.2, 3.5, and 2.7 pp, respectively. Timely introduction and intake of foods promoted by the interventions improved significantly, but anthropometric outcomes did not. We also observed a dose-response association between health post visits and early initiation of BF (OR: 1.8); higher numbers of home visits by community volunteers and key messages recalled were associated with 1.8–4.4 times greater odds of achieving MDD, MMF, and MAD, and higher numbers of radio spots heard were associated with 3 times greater odds of achieving MDD and MAD. The interventions were associated with plausible improvements in IYCF practices, but large gaps in improving children’s diets in Ethiopia remain, particularly during complementary feeding.

Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia

“…The trial aimed to deliver the MNP locally branded as Desta and infant and young child (IYC) feeding BCC activities to approximately 71,000 children 6–23 months in six woredas in Amhara Region (Kobo, Gubalafto, Delanta, Dessie Zuria, Kalu and Bati) and five woredas in Tigray Region (Saesi Tsaedaemba, Mereb Lehe, Werie Lehe, Gulomahda and Ahferom). The distribution of Desta was integrated into the IYC feeding BCC strategy developed by Alive & Thrive and implemented through the MOH's Health Extension Program (Kim et al, , ). The MOH, Concern Worldwide and Global Alliance for Improved Nutrition created guidelines, a training manual, job aids and materials for caregivers, which included information on the composition and purpose of Desta , instruction on food preparation with Desta and contraindications and potential side effects of Desta (see Table SS1 in the supporting information for key messages regarding Desta that HEW and health centre workers were trained to provide to caregivers).…”

Social Franchising and a Nationwide Mass Media Campaign Increased the Prevalence of Adequate Complementary Feeding in Vietnam: A Cluster-Randomized Program Evaluation

“…In Bangladesh, the intervention consisted of outreach-based home counseling delivered by a nongovernmental organization (15). In Ethiopia, the CF counseling was delivered by outreach-focused governmental health system workers (16). In Vietnam, a health facility–based counseling approach was used.…”

“…Mass media (MM) and community mobilization (CM) were used in all 3 countries to complement interpersonal counseling (IPC). Thus far, these studies have shown varying, but positive, impacts on breastfeeding in all 3 contexts (16, 17) and on CF in Bangladesh and Ethiopia (15, 16). …”

The power of counseling: Changing maternal, infant, and young child nutrition and family planning practices in Dhamar, Yemen

“…Mothers and couples need ongoing counseling to reinforce continued use of new practices and the adoption of other new practices as they and their children reach new milestones. Nutrition outcomes have improved as exposure to counseling messages increased in community-based nutrition programs (BASICS, 2008;Kim et al, 2016).…”

“…Although the integration of FP and MIYCN information and services has numerous potential benefits, FP and MIYCN services are generally not offered together. Thus, opportunities for intensive interpersonal counseling for both FP and MIYCN, which has been shown to improve the uptake of health and nutrition practices, are being missed (Kim et al, 2016). The researchers sought to use research findings to identify successful strategies for increasing exposure to information about and uptake of optimal practices through integrated MIYCN and FP services, which has not been widely documented in the literature.…”