Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children's Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria

Valerie L Flax, Abiodun Ipadeola, Courtney H Schnefke, Sarah Kwasu, Abdulrahaman A Mikail, Sujata Bose, Alice O Brower, Susan Edwards, Valerie L Flax, Abiodun Ipadeola, Courtney H Schnefke, Sarah Kwasu, Abdulrahaman A Mikail, Sujata Bose, Alice O Brower, Susan Edwards

Abstract

Background: Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers.

Objectives: The aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers' and mothers' complementary feeding knowledge, and fathers' support for complementary feeding (secondary outcomes).

Methods: The 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media. Cross-sectional population-based surveys of cohabiting fathers and mothers with a child aged 6-23 mo were conducted, and regression models were used to compare results at baseline (n = 497) and endline (n = 495).

Results: Children's minimum dietary diversity did not change from baseline to endline (62% to 65%, P = 0.441). Children's consumption of fish (36% to 44%, P = 0.012) and eggs (8% to 20%, P = 0.004) and minimum meal frequency (58% to 73%, P < 0.001) increased. Fathers' and mothers' knowledge of the timing of introduction of different foods and meal frequency improved. Fathers' support for child feeding by providing money for food increased (79% to 90%, P < 0.001). Fathers' and mothers' reported intervention exposure was low (11-26% across types of SBCC). Child feeding outcomes were not associated with fathers' exposure. Children's odds of both fish and egg consumption increased significantly with mothers' exposure to community meetings, religious services, home visits, and television spots, and children's odds of minimum meal frequency increased significantly with mothers' exposure to home visits.

Conclusions: A multipronged SBCC intervention improved complementary feeding practices, fathers' and mothers' knowledge of complementary feeding, and fathers' support for complementary feeding, despite low levels of reported exposure, which may have been influenced by coronavirus disease 2019 (COVID-19) disruptions. This trial was registered at ClinicalTrials.gov as NCT04835662.

Keywords: Nigeria; children; complementary feeding; dietary diversity; fathers; mHealth; meal frequency; mothers; social behavior change communication; sub-Saharan Africa.

© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Theory of change for the Igabi LGA Alive & Thrive complementary feeding study. CBO, community-based organization; CHEW, community health extension worker; LGA, local government area; SBCC, social and behavior change communication; TV, television.
FIGURE 2
FIGURE 2
Study flow diagram for the Igabi LGA Alive & Thrive complementary feeding study. LGA, local government area.

References

    1. Pan American Health Organization; WHO . Guiding principles for the complementary feeding of the breastfed child. Washington (DC): Pan American Health Organization; 2003.
    1. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;8:CD003517.
    1. WHO . Indicators for assessing infant and young child feeding practices: part 1 definitions. Geneva (Switzerland): WHO; 2008.
    1. WHO; United Nations Children's Fund (UNICEF) . Indicators for assessing infant and young child feeding practices: definitions and measurement methods [Internet]. Geneva (Switzerland): WHO and UNICEF; 2021. Available from: .
    1. White JM, Begin F, Kumapley R, Murray C, Krasevec J. Complementary feeding practices: current global and regional estimates. Matern Child Nutr. 2017;13:e12505.
    1. Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practies for children aged 24 months and under. Cochrane Database Syst Rev. 2018;5:CD011768.
    1. Bhandari N, Mazumder S, Bahl R, Martines J, Black RE, Bhan MK, Infant Feeding Study Group . An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. J Nutr. 2004;134:2342–48.
    1. Guldan GS, Fan H-C, Ma X, Ni Z-Z, Xiang X, Tang M-Z. Culturally appropriate nutrition education improves infant feeding and growth in rural Sichuan. J Nutr. 2000;130(5):1204–11.
    1. Roy SK, Fuchs GJ, Mahmud Z, Ara G, Islam S, Shafique S, Akter SS, Chakraborty B. Intensive nutrition education with or withoutout supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh. J Health Popul Nutr. 2005;23:320–30.
    1. Kilaru A, Griffiths PL, Ganapathy S, Ghosh S. Community-based nutrition education for improving infant growth in rural Karnataka. Indian Pediatr. 2005;42:425–32.
    1. Shi L, Zhang J, Wang Y, Caulfield LE, Guyer B. Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial. Public Health Nutr. 2010;13(4):556–65.
    1. Kim SS, Rawat R, Mwangi EM, Tesfaye R, Abebe Y, Baker Jet al. . Exposure to large-scale social and behavior change communication interventions is associated with improvement in infant and young child feeding practices in Ethiopia. PLoS One. 2016;11(10):e0164800.
    1. Kim SS, Nguyen PH, Mai L, Alayon S, Menon P, Frongillo EA. Different combinations of behavior change interventions and frequencies of interpersonal contacts are associated with infant and young child feeding practices in Bangladesh, Ethiopia, and Vietnam. Curr Dev Nutr. 2020;4(2):nzz140, 10.1093/cdn/nzz140.
    1. Fabrizio CS, van Liere M, Pelto G. Identifying determinants of effective complementary feeding behaviour change interventions in developing countries. Matern Child Nutr. 2014;10(4):575–92.
    1. Aubel J. The role and influence of grandmothers on child nutrition: culturally designated advisors and caregivers. Matern Child Nutr. 2012;8(1):19–35.
    1. Bilal S, Spigt M, Czabanowska K, Mulugeta A, Blanco R, Dinant G. Fathers' perceptions, practice, and challenges in young child care and feeding in Ethiopia. Food Nutr Bull. 2016;37(3):329–39.
    1. Chinkonde JR, Hem MH, Sundby J. HIV and infant feeding in Malawi: public health simplicity in complex social and cultural contexts. BMC Public Health. 2012;12(1):700.
    1. Thet MM, Khaing EE, Diamond-Smith N, Sudhinaraset M, Oo S, Aung T. Barriers to exclusive breastfeeding in the Ayeyarwaddy region of Myanmar: qualitative findings from mothers, grandmothers, and husbands. Appetite. 2016;96:62–9.
    1. Bezner Kerr R, Dakishoni L, Shumba L, Msachi R, Chirwa M. “We grandmothers know plenty”: breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi. Soc Sci Med. 2008;66(5):1095–105.
    1. Martin SL, McCann JK, Gascoigne E, Allotey D, Fundira D, Dickin KL. Mixed-methods systematic review of behavioral interventions in low- and middle-income countries to increase family support for maternal, infant, and young child nutrition during the first 1000 days. Curr Dev Nutr. 2020;4(6):nzaa085.
    1. Thuita F. Engaging grandmothers and men in infant and young child feeding and maternal nutrition [Internet]. Nairobi (Kenya): USAID Infant and Young Child Nutrition Project; 2011. [Cited 2021 Jan 20]. Available from: .
    1. Mukuria AG, Martin SL, Egondi T, Bingham A, Thuita FM. Role of social support in improving infant feeding practices in western Kenya: a quasi-experimental study. Glob Health Sci Pract. 2016;4(1):55–72.
    1. Flax V, Amer S, Unangst J, Karns S, Boman CK, Singh Ket al. . Alive & Thrive Nigeria: baseline household survey report. Research Triangle Park (NC): RTI International; 2018.
    1. Schnefke C, Flax V, Kaliyad C, Ubanhmen F. Alive & Thrive Nigeria: baseline qualitative data report. Research Triangle Park (NC): RTI International; 2017.
    1. Sanghvi T, Jimerson A, Hajeebhoy N, Zewale M, Nguyen GH. Tailoring communication strategies to improve infant and young child feeding practices in different country settings. Food Nutr Bull. 2013;34(3 Suppl 2):S169–80.
    1. WHO . Indicators for assessing infant and young child feeding practices: part 2 measurement. Geneva (Switzerland): WHO; 2010.
    1. National Population Commission, ICF . Nigeria Demographic and Health Survey 2018. Abuja (Nigeria) and Rockville (MD): National Population Commission and ICF; 2019.
    1. Ballard T, Coates J, Swindale A, Deitchler M. Household hunger scale: indicator definition and measurement guide. Washington (DC): FANTA III, FHI 360, USAID, FAO, Tufts University; 2011.
    1. DeLorme A, Gavenus ER, Salmen CR, Benard GO, Mattah B, Bukusi Eet al. . Nourishing networks: a social-ecological analysis of a network intervention for improving household nutrition in western Kenya. Soc Sci Med. 2018;197:95–103.
    1. Flax VL, Chapola J, Mokiwa L, Mofolo I, Swira H, Hosseinipour MCet al. . Integrating infant and young child feeding learning sessions into savings groups is feasible and acceptable for HIV-positive and HIV-negative women in Malawi. Matern Child Nutr. 2019;15(3):e12765.
    1. Kim SS, Roopnaraine T, Nguyen PH, Saha KK, Bhuiyan MI, Menon P. Factors influencing the uptake of a mass media intervention to improve child feeding in Bangladesh. Matern Child Nutr. 2018;14(3):1–11.
    1. Satzinger F, Kerr RB, Shumba L. Intergenerational partcipatory discussion groups foster knowledge exchange to improve child nutrition and food security in northern Malawi. Ecol Food Nutr. 2009;48(5):369–82.
    1. Murphy SP, Allen LH. Nutritional importance of animal source foods. J Nutr. 2003;133(11):3932S–5S.
    1. Iannotti LL. The benefits of animal products for child nutrition in developing countries. Revue Scientifique et Technique de L'Oie. 2018;37(1):37–46.
    1. Hirvonen K. Rural-urban differences in children's dietary diversity in Ethiopia: a Poisson decomposition analysis [Internet]. Washington (DC): IFPRI; 2016. [Cited 2021 Jan 22]. Available from: .
    1. Kim SS, Nguyen PH, Yohannes Y, Abebe Y, Tharaney M, Drummond Eet al. . Behavior change interventions delivered through interpersonal communication, agricultural activities, community mobilization, and mass media increase complementary feeding practices and reduce child stunting in Ethiopia. J Nutr. 2019;149(8):1470–81.
    1. Kruse C, Betancourt J, Ortiz S, Valdes Luna SM, Bamrah IK, Segovia N. Barriers to the use of mobile health in improving health outcomes in developing countries: systematic review. J Med Internet Res. 2019;21(10):e13263.
    1. Patel A, Kuhite P, Puranik A, Khan SS, Borkar J, Dhande L. Effectiveness of weekly cell phone counselling calls and daily text messages to improve breastfeeding indicators. BMC Pediatr. 2018;18(1):337.
    1. Downs SM, Sackey J, Kalaj J, Smith S, Fanzo J. An mHealth voice messaging intervention to improve infant and young child feeding practices in Senegal. Matern Child Nutr. 2019;15(4):e12825.
    1. Ezezika O, Oh J, Edeagu N, Boyo W. Gamification of nutrition: a preliminary study on the impact of gamification on nutrition knowledge, attitude, and behaviour of adolescents in Nigeria. Nutr Health. 2018;24(3):137–44.
    1. Sardi L, Idri A, Fernandez-Aleman JL. A systematic review of gamification in e-Health. J Biomed Inform. 2017;71:31–48.
    1. Ambikapathi R, Passarelli S, Madzorera I, Canavan CR, Noor RA, Abdelmenan Set al. . Men's nutrition knowledge is important for women's and children's nutrition in Ethiopia. Matern Child Nutr. 2021;17:e13062.
    1. Bimpong KA, Cheyuo EK-E, Abdul-Mumin A, Ayanore MA, Kubuga CK, Mogre V. Mothers' knowledge and attitudes regarding child feeding recommendations, complementary feeding practices and determinants of adequate diet. BMC Nutr. 2020;6(1):67.
    1. Przyrembel H. Timing of introduction of complementary food: short- and long-term health consequences. Ann Nutr Metab. 2012;60(s2):8–20.
    1. Dhami MV, Ogbo FA, Osuagwu UL, Ugboma Z, Agho KE. Stunting and severe stunting among infants in India: the role of delayed introduction of complementary foods and community and household factors. Global Health Action. 2019;12(1):1638020.
    1. Thuita FM, Martin SL, Ndegwa K, Bingham A, Mukuria AG. Engaging fathers and grandmothers to improve maternal and child dietary practices: planning a community-based study in western Kenya. Afr J Food Agric Nutr Dev. 2015;15:10387–405.
    1. Moyo SA, Schaay N. Fathers perceptions and personal experiences of complementary feeding of children 6 to 23 months in south-western Zimbabwe. World Nutr. 2019;10(3):51–66.
    1. Chintalapudi N, Hamela G, Mofolo I, Maman S, Hosseinipour MC, Hoffman IFet al. . Infant and young child feeding decision making and practices: Malawian mothers' and fathers' roles in the context of HIV. J Hum Lact. 2018;34(1):68–76.
    1. Kansiime N, Atwine D, Nuwamanya S, Bagenda F. Effect of male involvement on the nutritional status of children less than 5 years: a cross sectional study in a rural southwestern district of Uganda. J Nutr Metab. 2017;2017:3427087.
    1. Swinnen J, McDermott Jeditors. COVID-19 & global food security. Washington (DC): IFPRI; 2020.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner