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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Date
2019-06
Authors
Remilekun, Akinrinmade
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
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.
Description
A Research Thesis Submitted in Fulfilment of the
Requirements for the Award of the Degree of Doctor of
Philosophy in Food, Nutrition and Dietetics in the School
of Public Health and Applied Human Sciences, Kenyatta
University, June, 2019