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Evaluation of an Innovative Feeding Toolkit to Improve Complementary Feeding and Child Growth in Rural Malawi
Author(s) -
Faerber Emily C.,
Ko Jasmine,
Weiss Jennifer,
Girard Amy Webb
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.165.2
Subject(s) - medicine , meal , psychological intervention , nutrition education , logistic regression , demography , odds , environmental health , intervention (counseling) , gerontology , nursing , pathology , sociology
Background Inadequate complementary feeding (CF) is recognized as a cause of growth failure, but there is considerable variability in the ability of interventions to impact growth through CF practices. Objective To evaluate the effectiveness of a feeding toolkit which aims to improve child growth through improved meal frequency, meal volume and food consistency in rural Malawi. Methods Households in Mchinji district, Malawi with a child aged 6 to 17 months were selected via single stage cluster sampling based on caregivers' participation in community women's groups; 923 households from 53 communities completed a baseline survey in July/August 2015 and an endline survey in June 2016. In October/November of 2015, women's groups were randomized to either the intervention or control, with households in intervention communities eligible to receive a feeding toolkit consisting of a feeding bowl with demarcations and symbols that cued age‐appropriate meal frequency and volume; a slotted spoon designed to promote optimal porridge consistency; and nutrition education. Caregivers in the control groups received nutrition education. Logistic and linear regression was used to assess the impact of the feeding toolkit on CF practices and changes in child weight‐ and height‐for‐age (WAZ, HAZ) and weight‐for‐height (WHZ) z‐scores adjusted for covariates. Results The mean child age at endline was 21.3 ± 3.3 months, with 51% female. Receipt of the toolkit was associated with increased meal volume (β=30 ml, 95% CI 14 ml, 46 ml) but not with the odds of meeting minimum dietary diversity (P=0.6) or minimum acceptable diet (P=0.7). There was evidence of interaction between toolkit receipt and food security for minimum meal frequency (P=0.06) and consistency (P=0.07). The toolkit improved odds of minimum meal frequency (OR=1.55, 95% CI 1.10, 2.16) and was associated with increased meal thickness (β=0.24, 95% CI 0.12, 0.36) but only among moderate or severely food insecure households. There was a trend toward improved HAZ in children who received the toolkit (β=0.12, 95% CI=−0.01, 0.26, P = 0.07), but there were no associations with WAZ (P=0.6) or WHZ (P=0.3). Conclusion A feeding bowl and spoon with nutrition education was associated with improved meal volume in all households, and improved meal frequency and consistency in the most food insecure households. Further studies are warranted to understand the impact of such an intervention on linear growth. Support or Funding Information Funding and support for this research was provided by Concern Worldwide; Malawi Department of Nutrition, HIV and AIDS; World Bank; Emory Global Health Institute; Laney Graduate School, Emory University; and the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under award number T32DK007734.