Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh

Abstract

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6-23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2-0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99-1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11-0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01-27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11-1.57) in 6-23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06-0.49) and 0.16 (0.05-27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

Keywords: cluster randomised controlled trial; community based; counselling; dietary patterns; infant feeding; mHealth; nutrition education.

Figure 1

CONSORT diagram showing study arms and the number of participants available at follow‐up visits. BCC, behaviour change communication refers digital platform‐aided nutrition counselling; CNS, lipid‐based complementary nutrient supplement during 6–23 months of age; PNS, lipid‐based prenatal nutrient supplement

Figure 2

Effect of nutrition counselling using a digital job aid on dietary diversity score at different follow‐up visits between children 6 and 23 months of age and by household food security. *p‐value < 0.05, **p‐value < 0.01 indicate that the intervention effect is significant; interaction p‐value tests the null hypothesis that the effect of intervention is the same across all subgroups; ^Ψ Ns in household food insecurity subgroups represent number of children had feeding practice data for at least one follow‐up visit. CI, confidence interval

Figure 3

Effect of nutrition counselling using a digital job aid on minimum dietary diversity at different follow‐up visits between children 6 and 23 months of age and by household food security. *p‐value < 0.05, **p‐value < 0.01 indicate that the intervention effect is significant; interaction p‐value tests the null hypothesis that the effect of intervention is the same across all subgroups; ^Ψ Ns in household food insecurity subgroups represent number of children had feeding practice data for at least one follow‐up visit