Effect of nutrition education and psychosocial factors on child feeding practices: findings of a field experiment with biofortified foods and different women categories

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

Using preschoolers to improve caregivers' knowledge, attitude, and practices relating to biofortified crops: Evidence from a randomized nutrition education trial in Kenya

This 2018 randomized controlled trial examined the role behavioral nudges can play in improving caregivers' knowledge, attitude, and practices (KAP) relating to biofortified orange‐fleshed sweetpotato (OFSP). The experiment involved 431 preschooler–caregiver pairs in 15 villages. The preschoolers were enrolled in public‐run Early Childhood Development and Education (ECDE) centers in the respective villages. Caregivers were first exposed to the routine OFSP promotion activities in the area – invited to cooking demonstration workshops and issued with free OFSP vines to plant. A baseline survey followed. Next, the 15 villages were randomized into four study groups (a control and three treatments). The interventions were deployed for 30 days as follows: Treatment 1 – preschoolers issued OFSP‐branded exercise books, class posters, and poems; Treatment 2 – caregivers received phone‐mediated text messages; and Treatment 3 – received the full suite of interventions. This study analyzed the endline and baseline data and finds that, in general, changes in KAP scores were negatively associated with control group (p = .005) and positively associated with Treatment 3 (p = .02). Specifically, Treatment 3 significantly increased caregivers' knowledge of OFSP production, consumption, and vitamin A. Treatment 2 significantly improved their attitude too. It concludes that an integrated complementary nutrition education approach targeting preschooler–caregiver pairs is more effective in increasing knowledge of cultivation and consumption of OFSP. It discusses the implications for the design of more effective nutrition programs targeting households with preschoolers to accelerate the fight against vitamin A deficiency (VAD).

Do Nutrition Education Approaches With Preschoolers and Their Caregivers Influence Retention of Biofortified Orange-Fleshed Sweet Potato on Farms? Evidence From Homa Bay County, Kenya

BACKGROUND

Biofortified staples have been promoted widely in sub-Saharan Africa to combat micronutrient deficiencies. Contemporary projects are increasingly using elementary schools to target households with these foods.

OBJECTIVE

This study assessed the effects of integrated nutrition education approaches, targeting preschoolers and their caregivers, on retention of orange-fleshed sweet potato (OFSP) on farms in the second season after lapse of free vine dissemination initiatives.

METHODS

Rural farming households, with preschoolers and no prior engagement with OFSP, were targeted. A multistage sample of 431 preschooler-caregiver pairs was recruited for a cluster-randomized controlled trial. After issuing routine OFSP promotion activities, 15 village-level clusters of the pairs were randomized into 1 control group (3 villages) and 3 treatment arms (4 villages each) for the interventions. Baseline and follow-up household-level survey data were collected from the caregivers. The interventions included: (1) OFSP-branded exercise books, posters, and a poem to preschoolers only; (2) OFSP-oriented mobile phone mediated text messages to caregivers only; and (3) both 1 and 2 provided to individual households concurrently. Interventions 1 and 2 were single-channeled, while 3 was multichanneled. We estimated the intention-to-treat (ITT) and treatment-on-the-treated (TOT) effects using a binary logit model and a special regressor method, respectively.

RESULTS

Only the multi-channeled nutrition education approach had significant effects (ITT = 0.167, P = .001; TOT = .243, P = .007) on the caregivers' likelihood to retain OFSP on their farms.

CONCLUSIONS

The finding implies that multi-channeled agriculture nutrition education interventions through Early Childhood Development institutions can be effective in ensuring sustainable adoption of OFSP.

Marketing Healthy Food in an African City: Consumer Motivations for Adopting Orange-Fleshed Sweet Potato in Maputo, Mozambique

Since the late 1990s, the International Potato Center has promoted orange-fleshed sweet potato (OFSP) cultivars in Mozambique as a healthy food, emphasizing its capacity to reduce the prevalence of vitamin A deficiency among mothers and young children. This article seeks to reveal why consumers in Maputo, the capital city of Mozambique, adopt or reject OFSP looking at the role of food systems and consumer characteristics in access and acceptance of healthy food and at the positioning OFSP on the market in terms of lifestyle and need satisfaction.The results of 255 street interviews confirm that OFSP is widely known. Information reaches people mainly via informal channels (relatives and retailers). Nonadoption is the result of the positioning of OFSP as food for young children and sick people. The OFSP appeals most to the hedonistic and conservative lifestyle segments. Adoption is associated with the perception of OFSP as a source of vitamins that builds up muscles and improves physical appearance and self-fulfillment. While women are typically responsible for domestic tasks, male adopters emphasize the role of OFSP in family health and well-being more than female adopters. This first attempt to understand the marketing of healthy food in Mozambique exposes many similarities between the urban consumers in Maputo and those in developed countries. The results indicate that future marketing should exploit informal channels such as vendors and emphasize its nutritious value for all consumers instead of focusing on mothers and young children.

Do Market-oriented Engendered Agriculture-health Interventions Affect Household Nutrition Outcomes: Evidence from an Orange-fleshed Sweetpotato Project in Rwanda

The number of agricultural interventions promoting biofortified crops as a strategy to combat micronutrient malnutrition have increased significantly during the past decade. These interventions aim to improve the intake of key nutrients and sometimes other nutrition outcomes. In this study, we assess the impact of a market-oriented gender-sensitive agriculture-health project on household food consumption and food security. We use gender-disaggregated data from 842 sweetpotato farmers and a series of econometric techniques to assess the project's impact on food consumption household food security. The study finds unambiguous and strong impact of the project on both household food consumption and food security. Moreover, female-headed participant households benefitted much more from participation than did male-headed households. We further find that nonparticipant households would also have benefitted had they participated. The findings imply the importance of designing market-focused projects with a gender lens. They also imply that market-oriented agriculture-sensitive interventions do not necessarily harm the nutritional status of farm households.

Effects of Nutrition Education on Improving Knowledge and Practice of Complementary Feeding of Mothers with 6- to 23-Month-Old Children in Daycare Centers in Hawassa Town, Southern Ethiopia: An Institution-Based Randomized Control Trial

Undernutrition and hidden hunger threaten the survival, growth, and development of children, young people, economies, and nations. Inappropriate complementary feeding practice due to poor maternal knowledge and awareness in combination with low income and infectious disease is the contributing factor for child undernutrition. Hence, this study was aimed at determining the effect of nutrition education on improving the knowledge and practice of complementary feeding of the mothers with 6- to 23-month old children in daycare centers of Hawassa Town, Southern Ethiopia. An institution-based randomized control trial design was employed. Daycare centers were randomly allocated for the intervention group and the control group. Among the total daycare centers in the town, five were assigned to receive nutrition education and the rest five for the control group (CG). The simple random sampling technique used to select individual participants from each daycare center. Two hundred (200) mother-child pairs (100 for each group) were recruited. Sociodemographic and economic variables were collected by the structured questionnaire. Knowledge of appropriate complementary feeding was assessed by seven knowledge questions. Appropriate complementary feeding practice was assessed by adapting Alive and Thrive Infant and Young Child Feeding (IYCF) practice guidelines. Nutrition education was given for four consecutive months by using Alive and Thrive IYCF guidelines. Data were analyzed by the SPSS software program version 20. The chi-squared test was used to test the significant differences in the proportion of good knowledge and good practice of complementary feeding and good dietary diversity between two groups. The independent t test was used to test the significant differences in mean dietary diversity between two groups. At 95% confidence interval, p < 0.05 was considered statistically significant. The results revealed that the proportion of mothers with good knowledge of appropriate complementary feeding was increased from 59% at pretest to 96% at posttest and the appropriate complementary feeding practice was improved from 54% at pretest to 86% at posttest in IG. There was no change in the knowledge and practice of complementary feeding practice in CG after four months. The proportion of mothers with good complementary knowledge was 54% both at pretest and at posttest and good complementary feeding practice was 51% and 52% at pre- and posttest in CG, respectively. There was no significant difference (p > 0.05) on complementary feeding knowledge and practice between two groups at pretest, while the difference was highly significant (p < 0.05) at the posttest. In conclusion, providing nutrition education improved the appropriate complementary feeding knowledge and practice of mothers. In recommendation, government and other partners working on sustainable child nutrition reduction should focus on the nutrition education to improve the knowledge and appropriate complementary feeding practice including daycare centers.

Predictors of Intention to Integrate Biofortified Orange-fleshed Sweetpotato in Child Feeding: A Field Information Experiment in Rural Kenya

The study assesses the psychosocial predictors of intention to integrate biofortified pro-vitamin A orange-fleshed sweet potato (OFSP) in proper complementary feeding (PCF) among women who received either verbal or verbal and visual demonstrations on OFSP-based foods. A total of 764 randomly selected women grouped into four categories, namely pregnant women, women with infants, women with young children, and potential mothers, participated in this study. Using a structural equation model of predicted intentions based on an extended Theory of Planned Behavior (TPB) the study found goal-setting, perceived behavior control, subjective norms, and attitudes had a significant influence on intention to integrate OFSP in PCF. Unexpectedly, knowledge of the various health benefits of OFSP did not positively influence intention. Probabilistic recursive regression was then used to estimate the relationship between the intention to provide PCF practices and its potential antecedents. The results then showed that the model structure and explanatory power was information-specific and also revealing outcome differences by category of women. These results have implications on how interventions targeting the improvement of PCF should be organized and delivered. They underscore the need to segment the audience during nutrition education.