Does nutrition education improve complementary feeding practices and mothers nutrition knowledge? A case study of Western Kenya Jacqueline Kipkorir PhD Student , Kenyatta University 28th August 2014

Background I

• 35% of children in Kenya are stunted (KNBS & ICF Macro, 2010)

• Complementary foods in Kenya, consist of mostly grain and starchy staples and introduced early (KNBS & ICF Macro, 2010)

• Inadequate knowledge on appropriate foods and poor feeding practices is a greater determinant of malnutrition that actual lack of food among young children (Krebs et al, 2011)

• 600,000 child deaths can be prevented through adequate complementary feeding practices (Krebs et al., 2011)

Background II

• Adequate complementary feeding practices can help prevent stunting and iron deficiency (Smith & Haddad, 1999; Hotz & Gibson, 2005)

• Maternal education has a positive effect on complementary feeding practices and improved child health (Smith & Haddad, 1999;Shi & Zhang, 2010)

• Nutrition education improved breastfeeding practices and reduced growth faltering rates (Dewey & Adu-Afarwuah, 2008)

Overall Objective

To determine effect of nutrition education complementary feeding practices and

mothers nutrition knowledge

Study Hypotheses

H01: There is no significant difference between the control and intervention group with regard to complementary feeding practices.

H02: There is no significant difference between the control and intervention group with regard to maternal nutrition knowledge

Study Setting

8

VihigaUM1

>2000 mm

MumiasLM1

1800-2000 mm

9

Baseline survey in households with children 6-23 months and their caregivers Jul/Aug 2012 (n=300)

Restricted cluster randomization (using baseline results)District, AEZs, wealth index, stunting, CDDS, education level of caregivers

Nutrition education sessions on complementary feeding

Feb-Jun 2013

Endline survey in households children aged 6-23 months and their caregivers Jul/Aug 2013 ; Intervention group (n=101),Control group (n=100)

Intervention Group (10 villages) Control Group (10 villages)

Middle survey in same households with children 6-23 months and their caregiversto capture seasonal differences, Nov 2012 (n=218)

Study Flow

• Baseline survey• Households with caregivers and children 6-23 months• Two stage cluster sampling

15 villages randomly from each district proportional to population size 10 households randomly selected per village

• Intervention 10-15 caregivers with children 6-17 months in each intervention village

• Endline survey • Intervention group: All caregivers who participated in the NE• Control group: 10 households per village randomly selected

201 caregivers interviewed: Control (n=100), Intervention (n=101)

Study Population

Sessions Time Topics Materials

1 February • The importance of complementary feeding Main activity: participatory group discussions

IYCF materials

2 February- March

• Dietary diversity during complementary feeding

• Cooking demonstrationMain activities: participatory group discussions and cooking demonstration

Food circle, Seasonal food availability calendars,Locally available foods

General Elections in March 2013 and Follow-up visits in April 2013

3 May • Making nutritious and diverse meals for children aged 6-23 months

• Cooking demonstrationMain activities: participatory group discussions and cooking demonstration

IYCF materials, Food circle, Seasonal food availability calendars, Locally available foods

4 June • How to obtain and prepare adequate and nutritious meals for children 6-23 months

Main activities: group discussions and presentations

Posters, Brochures: Food circle, Nutritious snacks etc.

The themes and topics for the nutrition education sessions were selected based on the findings from the baseline survey with reference to materials from FAO 2004 and UNICEF 2012

Nutrition education sesssions

• Structured household questionnaires– Level of education– Occupation – Complementary feeding practices– Mothers knowledge on nutrition– etc.

• 24 hour recall and 7-day food frequency• Anthropometric measurements of mothers and children• Focus group discussions on complementary feeding

practices

Data Collection

© (FAO, 2011)

• Data was analysed using SPSS 22.0

• Dietary diversity scores (DDS): sum of food groups consumed during one day

– Child Dietary Diversity Score (CDDS): Maximum 7 food groups (WHO 2010)

– Women Dietary Diversity Score (FAO 2011) – Household Dietary Diversity Score (FAO 2011)

Data Analysis I

• Knowledge Assessment is based on 10 questions that assessed tested nutrition knowledge. Each question was given a maximum score of 6. Total Score was 60. The score was assigned as follows

• Mann-Whitney test and Chi Square statistics to test for significance

Data Analysis II

Attribute Score1 No Knowledge 02 Low Knowledge 1-123 Average Knowledge 13-244 Adequate Knowledge 25-365 Good knowledge 37-486 Excellent Knowledge 49-60

– Continued breastfeeding: Children 12-15 months of age who received breast milk in the previous day

– Minimum Dietary Diversity (MDD): > 4 food groups per day

– Minimum Meal Frequency (MMF): > 3 meals per day– Minimum Acceptable Diet (MAD): Children who received

> 4 food groups and > 3 meals a day– Consumption of iron fortified and iron rich foods:

number of children who received iron fortified foods divided by the number of children 6-23 months

WHO indicators on IYCF, 2010

Infant and Young Child Feeding(IYCF) Indicators

Results

Selected characteristics of study households (n=201)Characteristic Intervention Control

Mean SD Mean SD Age of mother (years) 30 7.2 30 9.4Age of child (months) 16 5.8 16 5.3Knowledge Score (mean) (0-60) 21 10.4 12.4 8.6Household size 6 2.2 5.7 2

Land acreage (acres) 0.9 1.0 0.7 0.8

CDDS (0-7) 4.11 1.0 3.2 1.1

HDDS (0-12) 7.72 1.2 7.13 1.3

Characteristic (%) Intervention Control

Marital Status

Married 92 94

Widowed/Single 8 6

Level of education (Mother)

Some p

rimary

Comple

ted pr

imary (s

tanda

rd 8)

Some s

econ

dary

Comple

ted Sec

onda

ry ( F

orm 4

0.010.020.030.040.050.060.070.080.090.0

100.0

InterventionControl

Characteristic Intervention (n=101) Control (n=100)Mean SD Mean SD

Exclusive breastfeeding (mean age)

4.5 2.3 3.2 2.2

Start of Complementary feeding 4.7 1.9 3.4 2.3Number of times semisolids and solids consumed previous day

4.7 1.2 4.5 1.2

Characteristic (%) Intervention Control

Pre-lacteal feeds 10.9 15

Fed liquids, solid or semi solid foods

100 100

Preparation of extra meal for child

79.8 74

Child still being breastfed 75.2 73

Complementary Feeding Practices I

Consumption of various food groups (Children)

Eggs

Legumes and nuts

Vitamin A rich fruits and vegetables

Fleshy and organ meat

Dairy products

Other fruits and vegetables

Grains,roots and tubers

0 20 40 60 80 100

Control Intervention

Complementary feeding practices I

Variablen

Intervention (%) n

Control (%) P

Minimum Dietary Diversity

74 73 42 42 <0.001

Minimum Meal Frequency

99 98 94 94 0.145

Consumption of iron fortified and iron rich foods

61 60 49 49 <0.001

* Chi Square test

Knowledge Assessment

Variable n Intervention n Control P

Knowledge Score (mean, SD)

101 20.7(10.4) 100

12.4 (8.6)

<0.001

1 No Knowledge (%) 3 3 12 12

2 Low knowledge (%) 21 20.8 37 37

3 Average knowledge (%)

40 39.6 43 43

4 Adequate knowledge (%)

32 31.7 7 7

5 Good knowledge (%) 5 5 1 1

6 Excellent Knowledge (%)

0 0 0 0

* Mann-Whitney

Conclusion & Recommendations

• Nutrition education was beneficial in improving MDD and Consumption of iron rich foods. Reject hypothesis 1

• Nutrition Education was beneficial in improving maternal nutritional knowledge. Reject hypothesis 2

Conclusion

Recommendation

• More focus on nutrition education as an intervention together with other IYCF strategies to improve infant and young child feeding practices

• Development of a curriculum for nutrition education specifically targeted at complementary feeding to go hand in hand with other available IYCF materials

• Determination of nutrient quality of locally available foods to be used in complementary feeding

Next Steps• Data analysis to continue using baseline, middle and endline

– Differences in difference test to be applied to baseline and end line data to allow for comparison.

– Comparison of baseline and end line; Intervention and Control with regard to

• Complementary feeding practices (Frequency, Amount and Dietary diversity)

• Maternal nutritional knowledge • Nutrient intake• Nutritional status of children• Determine if nutritional knowledge of the mothers has an effect

on practice – Perform further statistical analysis

• Federal Ministry of Economic Cooperation and Development, Germany and the CGIAR Research Programme on Agriculture for Nutrition and Health(A4NH) for funding

• Supervisors– Prof Judith Kimiywe– Dr. Gudrun Keding

• Bioversity International• Study participants• INULA colleagues

Acknowledgement

www.bioversityinternational.org

Thank you