The Role of Targeted Nutrition Education of Preschoolers and Caregivers on Sustained Consumption of Biofortified Orange-Fleshed Sweetpotato in Kenya

Abstract

Background: Persistent prevalence of high malnutrition in poor households in developing countries calls for enhancement of cost-effective nutrition interventions among the vulnerable groups. One responsive way is to promote regular consumption of home-grown biofortified foods, particularly in the micronutrient-deficient groups. Previous nutrition interventions have targeted adults with behavior change education, but have rarely explored the potential of nutrition education of preschoolers as change agents.

Objectives: This study sought to assess the effect of nutrition education targeting preschool children and their caregivers on their consumption of vitamin A-biofortified orange-fleshed sweetpotato (OFSP) in rural farm households in Homa Bay County, Kenya.

Methods: A total of 431 preschooler-caregiver pairs from 15 village-level clusters were recruited into a randomized controlled trial. The sample was randomized into 1 control (3 villages) and 3 treatment groups (4 villages each). Treatments involved channeling nutrition education to preschoolers through their learning materials (preschooler treatment); the caregivers through their mobile phones (caregiver treatment); and to both preschoolers and their caregivers simultaneously (integrated treatment). Baseline and follow-up household-level surveys were conducted with the caregivers, and consumption data were collected from the preschoolers using a child dietary diversity register. Class teachers sought 24-h consumption recalls of the preschoolers for 19 consecutive schooldays.

Results: The results of a zero-inflated Poisson regression showed that the phone-mediated and multichanneled nutrition education approaches significantly increased the number of days of OFSP consumption. The integrated nutrition education approach significantly increased the preschoolers' likelihood to consume OFSP, number of OFSP consumption days, and likelihood to consume it more than once per week by 11%, 77%, and 20%, respectively.

Conclusions: Nutrition education through OFSP-branded preschoolers' learning materials and phone-mediated messages provides effective nudges to the caregivers to feed their preschoolers regularly with OFSP. This could have implications for realizing sustainable nutrition programs in biofortified crop-growing areas.

Keywords: Kenya; OFSP consumption; caregivers; nutrition education; preschoolers; vitamin A deficiency.

FIGURE 1

CONSORT diagram for the study: study design, activity protocol, and details. The left side of the chart shows the main activities in order of execution from top to the bottom, from the early stages involving recruitment of participants to the final stages describing the data presented for analysis. The details of the activities are presented in the corresponding boxes to the right. OFSP, orange-fleshed sweetpotato.

FIGURE 2

Distribution of consumers of OFSP across the study groups and by OFSP production status. Data are percentages of those who consumed OFSP in the respective subsamples. CT, caregiver treatment group; IT, integrated treatment group; OFSP, orange-fleshed sweetpotato; PT, preschooler treatment group.

FIGURE 3

Percentage of preschoolers by OFSP production and number of OFSP consumption days in the study groups. Data are percentages of preschoolers in the respective subsamples (by production and study groups) who consumed OFSP for the different number of days, on the horizontal axis, during the 19 d of food consumption recalls. Did not produce OFSP (n = 151); produced OFSP (n = 222); control group (n = 98). CT, caregiver treatment group (n = 126); IT, integrated treatment group (n  = 70); OFSP, orange-fleshed sweetpotato; PT, preschooler treatment group (n = 73).