Effect of Nutrition Education on Complementary Feeding Practices and Nutrition Status of Infants: A Cluster Randomized-Trial in Ondo State, Nigeria
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Malnutrition during infancy has been linked to lack or poor knowledge of appropriate feeding practices among caregivers. This study investigated the effect of nutrition education on adequate complementary feeding practices among caregivers as well as the nutrition status of infants (5-11months) in Ondo State, Nigeria. The study adopted cluster randomized controlled trial design. The study participants were assigned to two groups. One intervention and one control group in a ratio of 1:1. The sample size was 142 for intervention group and 142 for the control group. Nutrition education on complementary feeding was carried out among the caregivers in the intervention group and the control group received no nutrition education from the research team. The participants in the intervention group received four (4) lesson sessions per group. The lesson sessions were based on timely introduction of complementary feeding, meal frequency and planning, dietary diversity, minimum acceptable diet, hygiene and responsive feeding. To determine the complementary feeding knowledge, attitude and practices of the caregivers as well as the nutrition status of the infants, data were collected from caregivers at the infants’ age 6, 8 and 11 months. For knowledge and attitude, complementary feeding knowledge and attitude based questionnaire were used. For complementary feeding practices, 24-hr dietary recall was used and nutrition status assessment instruments were used to determine the infants’ nutrition status. Focus group discussions and key informant interviews were conducted for qualitative data. Data were analyzed using SPSS version 22.0. From the analysis, there was no significant difference in demographic and socio-economic status of the caregivers. There was a significant difference in the complementary feeding mean knowledge score of the caregivers after the intervention at the endline (4.0; p<0.001) and the (Difference in Difference (DID) between baseline and the endline was 4.06 (p<0.001) and the complementary feeding mean attitude score of the caregivers was 3.82; p<0.001) at the endline. The mean nutrients intake of the infants in the intervention group was higher than the control group as analyzed by nutri-survey. The mean energy intake of infants in the intervention group was higher both at the midline (259g±20.67) and at the endline (366.7g±23.03) than those in the control group both at the midline (121.1g±17.05) and the endline (212g±22.04), these were both significant (p<0.001). From Kaplan-Meier analysis, continued breastfeeding survival at age 11 months was 94.4% in the intervention group and it was 69.7% in the control group (p<0.001). Adjusted Relative Risk (ARR) was used to determine the effect of nutrition education on the intervention group and control group for variables such as Minimum Acceptable Diet (ARR: 3.13; CI:2.53-5.16; P<0.001) at the endline. There was a significant difference in WAZ (t.test; p<0.001), WHZ (t-test; p<0.001) and in HAZ (t-test; p=0.049). The infants in the intervention group had improved nutritional status than the infants in the control group. This study concluded that nutrition education based on complementary feeding guidelines improved the feeding practices of the caregivers. Therefore, the study recommends that Ministry of Health in Ondo State should encourage complementary feeding training for caregivers and CHEWs at the various Basic Health Centers in the State.