Improving caregivers’ infant and young child-feeding practices using a three-group food guide: A randomized intervention study in central Uganda

Abstract

Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30 years remained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%, respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples, there is need to improve the population’s awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards) that were developed by United Nations Children’s Fund (UNICEF), are currently the standard package used in Uganda’s health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards. A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a threefood group guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status. At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores, which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p = 0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-forage (p = 0.03) Z-scores. These findings, therefore, indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards. Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth.