Effectiveness of a community-based nutrition programme to improve child growth in rural Ethiopia: a cluster randomized trial

Abstract

Few trials have shown that promoting complementary feeding among young children is effective in improving child linear growth in resource-challenged settings. We designed a community-based participatory nutrition promotion (CPNP) programme adapting a Positive Deviance/Hearth approach that engaged mothers in 2-week nutrition sessions using the principles of 'learning by doing' around child feeding. We aimed to test the effectiveness of the CPNP for improving child growth in rural Ethiopia. A cluster randomized trial was implemented by adding the CPNP to the existing government nutrition programmes (six clusters) vs. government programmes only (six clusters). A total of 1790 children aged 6 to 12 months (876 in the intervention and 914 in the control areas) were enrolled and assessed on anthropometry every 3 months for a year. Multi-level mixed-effect regression analysis of longitudinal outcome data (n = 1475) examined the programme impact on growth, adjusting for clustering and enrollment characteristics. Compared with children 6 to 24 months of age in the control area, those in the intervention area had a greater increase in z scores for length-for-age [difference (diff): 0.021 z score/month, 95% CI: 0.008, 0.034] and weight-for-length (diff: 0.042 z score/month, 95% CI: 0.024, 0.059). At the end of the 12-month follow-up, children in the intervention area showed an 8.1% (P = 0.02) and 6.3% (P = 0.046) lower prevalence of stunting and underweight, respectively, after controlling for differences in the prevalence at enrollment, compared with the control group. A novel CPNP programme was effective in improving child growth and reducing undernutrition in this setting. © 2016 John Wiley & Sons Ltd.

Keywords: Ethiopia; childhood stunting; cluster randomized trial; community-based participatory nutrition promotion; complementary feeding practices; effectiveness evaluation.

Figure 1

Consort diagram for trial participants from enrollment through 12‐month follow‐up, Habro and Melka Bello districts, Ethiopia. CMAM, community‐based management of acute malnutrition; CPNP, community‐based participatory nutrition promotion; ENA, Essential Nutrition Action. ^*Unmet: the subject moved out of the area or was not at home at the time of the survey visit. ^†Refused: the subject decided not to participate at the time of the survey.

Figure 2

Predicted length‐for‐age z score (A), weight‐for‐age z score (B), weight‐for‐length z score (C), length (D) and weight (E) of children 6 to 24 months of age in control and intervention areas. The graphs were produced by locally weighted regression on the predicted values derived from linear mixed‐effect regression models including age quadratic term (n = 725 children in control area; n = 750 children in intervention area). The Lowess curves had a bandwith of 0.8.