Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh

Abstract

Background: Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010-2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity.

Objective: We assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + less intensive CM and MM) 2 y after termination of initial external donor support.

Methods: We used a cluster-randomized design with repeated cross-sectional surveys at baseline (2010, n = 2188), endline (2014, n = 2001), and follow-up (2016, n = 2400) in the same communities, among households with children 0-23.9 mo of age. Within-group differences over time and differences between groups in changes were tested.

Results: In intensive areas, exposure to IPC decreased slightly between endline and follow-up (88.9% to 77.2%); exposure to CM activities decreased significantly (29.3% to 3.6%); and MM exposure was mostly unchanged (28.1-69.1% across 7 TV spots). Exposure to interventions did not expand in nonintensive areas. Most IYCF indicators in intensive areas declined from endline to follow-up, but remained higher than at baseline. Large differential improvements of 12-17 percentage points in intensive, compared with nonintensive areas, between baseline and follow-up remained for early initiation of and exclusive breastfeeding, timely introduction of foods, and consumption of iron-rich foods. Differential impact in breastfeeding knowledge remained between baseline and follow-up; complementary feeding knowledge increased similarly in both groups.

Conclusions: Continued IPC exposure and sustained impacts on IYCF knowledge and practices in intensive areas indicated lasting benefits from A&T's interventions as they underwent major scale-up with reduced intensity. This trial was registered at clinicaltrials.gov as NCT02740842.

FIGURE 1

Trial profile.

FIGURE 2

Breastfeeding practices, by program group and survey round. (A) Early initiation of breastfeeding and (B) exclusive breastfeeding. *,**,***Significantly different DDEs with clustered SEs comparing intensive and nonintensive areas from baseline to endline or baseline to follow-up, accounting for geographic clustering at upazila and district levels. *P < 0.05, **P < 0.01, ***P < 0.001. ^##,###Significant change from endline to follow-up: ^##P < 0.01, ^###P < 0.001. DDE, difference-in-difference estimate; T, time.

FIGURE 3

Complementary feeding practices, by program group and survey round. (A) Introduction of SSSF, (B) minimum dietary diversity, (C) minimum meal frequency, and (D) consumption of iron-rich foods. *,**,***Significantly different DDEs with clustered SEs comparing intensive and nonintensive areas from baseline to endline or baseline to follow-up, accounting for geographic clustering at upazila and district levels. *P < 0.05, **P < 0.01, ***P < 0.001. ^#,##Significant change from endline to follow-up: ^#P < 0.05, ^##P < 0.05. DDE, difference-in-difference estimate; SSSF, solid, semi-solid, or soft food; T, time.

FIGURE 4

BF (A) and CF (B) knowledge scores among mothers with children aged 0–23.9 mo, by program group and survey round. *,***Significantly different DDEs with clustered SEs comparing intensive and nonintensive areas from baseline to endline or baseline to follow-up, accounting for geographic clustering at upazila and district levels. *P < 0.05, ***P < 0.001. ^##,###Significant change from endline to follow-up: ^##P < 0.01, ^###P < 0.001. BF, breastfeeding; CF, complementary feeding; DDE, difference-in-difference estimate; T, time.