Role of Mitanin community health workers in improving complementary feeding practices under scaled-up home-based care of young children in a rural region of India

Abstract

Background: A large proportion of young children in developing countries receive inadequate feeding and face frequent infections. Global research has established the need for improving feeding practices and management of child illnesses. Interventions involving home visits by community health workers (CHWs) for caregiver education have been attempted in many countries. Indian government rolled out an intervention called home-based care of young children (HBYC) in 2018 but no studies exist of its scaled-up implementation. The current study was aimed at assessing the coverage of HBYC in Chhattisgarh state where it has been implemented through 67,000 rural CHWs known as Mitanins.

Methods: This cross-sectional study was based on a primary household survey. Households with children in 7-36 months age were eligible for survey. A multi-stage sample of 2646 households was covered. Descriptive analyses were performed and key indicators were reported with 95% confidence intervals. To find out the association between caregiver practices and receiving advice from the CHWs, multivariate regression models were applied.

Results: Overall, 85.1% children in 7-36 months age received at least one home visit from a CHW within the preceding three months. Complementary feeding had been initiated for 67% of children at six months age and the rate was 87% at eight months age. Around one-third of the children were fed less than three times a day. Around 41% households added oil in child's food the preceding day. CHWs were contacted in 73%, 69% and 61% cases of diarrhea, fever and respiratory infections respectively in children. Among those contacting a CHW for diarrhea, 88% received oral rehydration. The adjusted models showed that receiving advice from CHWs was significantly associated with timely initiation of complementary feeding, increasing the frequency of feeding, increasing diet diversity, addition of oil, weighing and consumption of food received from government's supplementary nutrition programme.

Conclusions: Along with improving food security of households, covering a large share of young children population with quality home visits under scaled-up CHW programmes can be the key to achieving improvements in complementary feeding and child care practices in developing countries.

Keywords: ASHA; Community health workers; Complementary feeding; Home based child care; India; Infant and young child feeding; Integrated management of child illness; Mitanin; Young child care.