Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia

"Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms:" interpersonal communication, nutrition-sensitive agricultural activities, community mobilisation, and mass media.

In order to evaluate the A&T behaviour change interventions, this study compared those infant and young child feeding (IYCF) practice interventions with nonintensive interventions including standard nutrition counseling and agricultural extension service and less intensive community mobilisation (CM) and mass media (MM) on CF practices and knowledge and child anthropometric outcomes.

In three zones of Amhara, Ethiopia, "A&T with Save the Children as its implementing partner worked with government health extension workers (HEWs), health development team leaders (HDTLs; a cadre of community health volunteers), and agricultural extension workers to deliver IYCF messages through interpersonal communication (IPC) and promote nutrition-sensitive agricultural activities (AG)...." Activities included counseling during health post visits and home visits and food demonstrations.  Priests and leaders delivered community activities such as sermons about adequate child feeding. "The mass media (MM) component, implemented in both intensive and nonintensive areas, consisted of a regional broadcast of radio drama called 'Sebat Mela' (translated as 'Seven Wisdoms'), which included 12 episodes with stories that aligned with A&T's IYCF messages, associated jingles, and testimonials of model mothers. In intensive areas with limited access to radio, supplemental activities were conducted, including broadcasting the radio drama through mobile vans with speakers and utilizing traveling performers to enact parts of the drama."

The evaluation methodology used was "cluster-randomized, nonblinded impact evaluation design with repeated cross-sectional surveys." Surveys were conducted at baseline and 2 years later to find primary outcomes on use of World Health Organization (WHO)-recommended core CF practices and secondary outcomes of maternal knowledge about CF and stunting prevalence among children aged 6–23.9 mo. Indicators included: 1) minimum dietary diversity; 2) minimum meal frequency; 3) minimum acceptable diet); 4) consumption of iron-rich or iron-fortified foods; and 5) timely introduction of solid, semisolid, or soft foods. "Maternal CF knowledge was assessed based on mothers’ responses to a set of 12 questions about CF."

Results showed levels of minimum dietary diversity and minimum acceptable diet improved significantly over time in both intensive and nonintensive groups, but the increases were marginally higher in the intensive group. Consumption of food items specifically promoted by the programme through messages and during food demonstrations was improved. In addition, there was significant impact on maternal CF knowledge scores, and stunting declined in both groups between baseline and endline "with significant differential improvement in favor of the intensive group ", as did underweight and wasting, which did not differ between groups.

The study concludes that this short term programme delivering social and behavior change interventions using multiple platforms was feasible and effective in improving complementary feeding practices and child stunting.