Effects of Complementary Feeding Counseling on Appropriate Complementary Feeding Practices and Child Undernutrition (ACFPsCF)

Effects of Complementary Feeding Counseling on Appropriate Complementary Feeding Practices and Child Undernutrition

Effects of Complementary Feeding Counseling on Appropriate Complementary Feeding Practices and Child Undernutrition in West Gojjam Zone, Northwest Ethiopia: Cluster Randomized Controlled Trial

Appropriate complementary feeding practices as per the world health organization recommendations is a window of opportunity to promote health and prevent acute and chronic under nutrition (stunting, wasting & underweight). Globally, the burden of under nutrition remains unacceptably high, and the progress of under nutrition reduction is unsatisfactorily slow. In Ethiopia, appropriate complementary feeding practices of mothers to their children are very low. In contrast, child under nutrition is a major public health problem.

Appropriate nutrition during the first 1000 days of life lays the foundation for a child's health and well-being. Introduction of complementary foods within 6-8 months of age and step-wise increase of diversified plant and animal-based diets is necessary, for which exclusive breast milk is no longer enough to meet the nutritional needs. Appropriate complementary feeding practices as per the world health organization recommendations is a window of opportunity to promote health and prevent acute and chronic under nutrition (stunting, wasting & underweight). Globally, the burden of under nutrition remains unacceptably high, and the progress of under nutrition reduction is unsatisfactorily slow. In Ethiopia, appropriate complementary feeding practices of mothers to their children are very low. In contrast, child under nutrition is a major public health problem. This study aims to determine the effects of complementary feeding counseling on appropriate complementary feeding practices and child under nutrition through a community based randomized controlled trial.

Complementary feeding counseling to the mother-child pairs, in the intervention clusters, will be given by trained women development army (WDA) team leaders. The intervention process will have two components; training of WDA leaders, and counseling of mothers. Counselors' training will be given centrally by the principal investigator. During counseling, WDA leaders will use a counseling guide, which is prepared in Amharic, the local and the national language. The counseling guide contains seven key messages; complementary feeding: at 6 months, from 6-8 months, from 9-11 months, from 12-23 months, hygiene, breast feeding a sick child greater than 6 months, and signs that require mothers' special care of their children. Starting the children's 6 months of age, participants in the intervention group will receive in group counseling at convenient places, and individual counseling at each mother-child pair's home every month for 9 consecutive months (a total of 9 months follow up).

Participants in the control clusters will receive the routine complementary feeding counseling, which is offered by heath extension workers and other health professionals.

Complementary Feeding Counseling to Improve Appropriate Complementary Feeding Practices and Reduce Child Undernutrition

Change from baseline in appropriate complementary feeding practices of mothers for their children at 9 months

Questions related to complementary feeding practices will be used to measure the complementary feeding practices of mothers for their children (Appropriate/Inappropriate). To measure appropriate complementary feeding practices of mothers, based on the world health organization recommendations for infant and young child feeding practices, continue of breast feeding, starting of solid, semi-solid or soft foods at 6 months of age, and egg &/or flesh food consumptions will be asked. Minimum dietary diversity, minimum meal frequency, and minimum acceptable diet will be determined. Appropriate complementary feeding practices is defined if the four indicators: timely introduction of complementary foods, minimum dietary diversity, minimum meal frequency, and egg &/or flesh food consumption are full filled. Otherwise, inappropriate if a child feeding practices do not fulfill even one of the components of appropriate complementary feeding practices.

The child nutritional status (Under nutrition/ No Under nutrition) will be determined by measuring the length, weight, and calculating the child's age. Length will be measured using a calibrated length board to the nearest 1mm (0.1cm). Weight will be measured using mechanical hanging scale with weighing pants to the nearest 10g at the time of enrolment and 100g at end-line measurements. Before weighing the child, the weight scale will be hung securely and set to zero. Child's age will be calculated by subtracting the child's date of birth from the date of baseline data collection. Undernutrition will be defined if a child is wasted, or underweight, or stunted. The child is wasted: when the weight-for-length-Z score (WLZ) is <-2 standard deviations; Underweight: when Weight-for-age Z score (WAZ) is <-2 standard deviations, and Stunted: when length-for-age Z score (LAZ) is <-2 standard deviations.

Inclusion Criteria: Mother-child pairs, whose children age is 6 months. Mother-child pairs who reside in the study area for at least 6 months before the survey Mother-child pairs who have no intention of leaving the study area during the intervention period. Exclusion Criteria: Mothers with severe mental illness or unable to communicate (e.g. deaf). Mother-child pairs with severe congenital malformations of their children.

Michaelsen KF, Grummer-Strawn L, Begin F. Emerging issues in complementary feeding: Global aspects. Matern Child Nutr. 2017 Oct;13 Suppl 2(Suppl 2):e12444. doi: 10.1111/mcn.12444.