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Does nutrition education improve complementary feeding practices?
This study investigates the impact of nutrition education on complementary feeding practices and maternal nutrition knowledge among caregivers in western Kenya, where malnutrition is prevalent. Results indicate that the intervention significantly improved maternal knowledge and dietary diversity among children, leading to the rejection of the study's initial hypotheses. The findings suggest enhanced focus on nutrition education as a key strategy to combat malnutrition in young children.
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Does nutrition education improve complementary feeding practices?
- 1. Does nutrition educationimprove complementary feeding practices and mothers nutrition knowledge? A case study of Western Kenya Jacqueline Kipkorir PhD Student , Kenyatta University 28th August 2014
- 2. Background I •35% of children in Kenya are stunted (KNBS & ICF Macro, 2010) • Complementary foods in Kenya, consist of mostly grain and starchy staples and introduced early (KNBS & ICF Macro, 2010) • Inadequate knowledge on appropriate foods and poor feeding practices is a greater determinant of malnutrition that actual lack of food among young children (Krebs et al, 2011) • 600,000 child deaths can be prevented through adequate complementary feeding practices (Krebs et al., 2011)
- 3. Background II •Adequate complementary feeding practices can help prevent stunting and iron deficiency (Smith & Haddad, 1999; Hotz & Gibson, 2005) • Maternal education has a positive effect on complementary feeding practices and improved child health (Smith & Haddad, 1999;Shi & Zhang, 2010) • Nutrition education improved breastfeeding practices and reduced growth faltering rates (Dewey & Adu-Afarwuah, 2008)
- 4. Overall Objective Todetermine effect of nutrition education complementary feeding practices and mothers nutrition knowledge
- 5. Study Hypotheses H01:There is no significant difference between the control and intervention group with regard to complementary feeding practices. H02: There is no significant difference between the control and intervention group with regard to maternal nutrition knowledge
- 6. Study Setting 8 Mumias LM1 1800-2000 mm Vihiga UM1 >2000 mm
- 7. Study Flow Baselinesurvey in households with children 6-23 months and their caregivers Middle survey in same households with children 6-23 months and their caregivers to capture seasonal differences, Nov 2012 (n=218) Intervention Group (10 villages) Control Group (10 villages) 9 Jul/Aug 2012 (n=300) Restricted cluster randomization (using baseline results) District, AEZs, wealth index, stunting, CDDS, education level of caregivers Nutrition education sessions on complementary feeding Feb-Jun 2013 Endline survey in households children aged 6-23 months and their caregivers Jul/Aug 2013 ; Intervention group (n=101),Control group (n=100)
- 8. Study Population •Baseline survey • Households with caregivers and children 6-23 months • Two stage cluster sampling 15 villages randomly from each district proportional to population size 10 households randomly selected per village • Intervention 10-15 caregivers with children 6-17 months in each intervention village • Endline survey • Intervention group: All caregivers who participated in the NE • Control group: 10 households per village randomly selected 201 caregivers interviewed: Control (n=100), Intervention (n=101)
- 9. Nutrition education sesssions Sessions Time Topics Materials 1 February • The importance of complementary feeding Main activity: participatory group discussions IYCF materials 2 February- March • Dietary diversity during complementary feeding • Cooking demonstration Main activities: participatory group discussions and cooking demonstration Food circle, Seasonal food availability calendars, Locally available foods General Elections in March 2013 and Follow-up visits in April 2013 3 May • Making nutritious and diverse meals for children aged 6-23 months • Cooking demonstration Main activities: participatory group discussions and cooking demonstration IYCF materials, Food circle, Seasonal food availability calendars, Locally available foods 4 June • How to obtain and prepare adequate and nutritious meals for children 6-23 months Main activities: group discussions and presentations Posters, Brochures: Food circle, Nutritious snacks etc. The themes and topics for the nutrition education sessions were selected based on the findings from the baseline survey with reference to materials from FAO 2004 and UNICEF 2012
- 10. Data Collection •Structured household questionnaires – Level of education – Occupation – Complementary feeding practices – Mothers knowledge on nutrition – etc. • 24 hour recall and 7-day food frequency • Anthropometric measurements of mothers and children • Focus group discussions on complementary feeding practices
- 11. © (FAO, 2011) Data Analysis I • Data was analysed using SPSS 22.0 • Dietary diversity scores (DDS): sum of food groups consumed during one day – Child Dietary Diversity Score (CDDS): Maximum 7 food groups (WHO 2010) – Women Dietary Diversity Score (FAO 2011) – Household Dietary Diversity Score (FAO 2011)
- 12. Data Analysis II • Knowledge Assessment is based on 10 questions that assessed tested nutrition knowledge. Each question was given a maximum score of 6. Total Score was 60. The score was assigned as follows Attribute Score 1 No Knowledge 0 2 Low Knowledge 1-12 3 Average Knowledge 13-24 4 Adequate Knowledge 25-36 5 Good knowledge 37-48 6 Excellent Knowledge 49-60 • Mann-Whitney test and Chi Square statistics to test for significance
- 13. Infant and YoungChild Feeding(IYCF) Indicators – Continued breastfeeding: Children 12-15 months of age who received breast milk in the previous day – Minimum Dietary Diversity (MDD): > 4 food groups per day – Minimum Meal Frequency (MMF): > 3 meals per day – Minimum Acceptable Diet (MAD): Children who received > 4 food groups and > 3 meals a day – Consumption of iron fortified and iron rich foods: number of children who received iron fortified foods divided by the number of children 6-23 months
- 14.
- 15. Selected characteristics ofstudy households (n=201) Characteristic Intervention Control Mean SD Mean SD Age of mother (years) 30 7.2 30 9.4 Age of child (months) 16 5.8 16 5.3 Knowledge Score (mean) (0-60) 21 10.4 12.4 8.6 Household size 6 2.2 5.7 2 Land acreage (acres) 0.9 1.0 0.7 0.8 CDDS (0-7) 4.11 1.0 3.2 1.1 HDDS (0-12) 7.72 1.2 7.13 1.3 Characteristic (%) Intervention Control Marital Status Married 92 94 Widowed/Single 8 6
- 16. Level of education(Mother) 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Some primary Completed primary (standard 8) Some secondary Completed Secondary ( Form 4 Intervention Control
- 17. Complementary Feeding PracticesI Characteristic Intervention (n=101) Control (n=100) Mean SD Mean SD Exclusive breastfeeding (mean age) 4.5 2.3 3.2 2.2 Start of Complementary feeding 4.7 1.9 3.4 2.3 Number of times semisolids and 4.7 1.2 4.5 1.2 solids consumed previous day Characteristic (%) Intervention Control Pre-lacteal feeds 10.9 15 Fed liquids, solid or semi solid 100 100 foods Preparation of extra meal for child 79.8 74 Child still being breastfed 75.2 73
- 18. Consumption of variousfood groups (Children) Grains,roots and tubers Other fruits and vegetables Dairy products Fleshy and organ meat Vitamin A rich fruits and… 0 20 40 60 80 100 Legumes and nuts Eggs Control Intervention
- 19. Complementary feeding practicesI Variable n Intervention (%) n Control (%) P Minimum Dietary Diversity 74 73 42 42 <0.001 Minimum Meal Frequency 99 98 94 94 0.145 Consumption of iron fortified and iron rich foods 61 60 49 49 <0.001 * Chi Square test
- 20. Knowledge Assessment Variablen Intervention n Control P Knowledge Score 101 20.7(10.4) 10 12.4 (mean, SD) 0 (8.6) <0.001 1 No Knowledge (%) 3 3 12 12 2 Low knowledge (%) 21 20.8 37 37 3 Average knowledge (%) 40 39.6 43 43 4 Adequate knowledge (%) 32 31.7 7 7 5 Good knowledge (%) 5 5 1 1 6 Excellent Knowledge (%) 0 0 0 0 * Mann-Whitney
- 21.
- 22. Conclusion • Nutritioneducation was beneficial in improving MDD and Consumption of iron rich foods. Reject hypothesis 1 • Nutrition Education was beneficial in improving maternal nutritional knowledge. Reject hypothesis 2
- 23. Recommendation • Morefocus on nutrition education as an intervention together with other IYCF strategies to improve infant and young child feeding practices • Development of a curriculum for nutrition education specifically targeted at complementary feeding to go hand in hand with other available IYCF materials • Determination of nutrient quality of locally available foods to be used in complementary feeding
- 24. Next Steps •Data analysis to continue using baseline, middle and endline – Differences in difference test to be applied to baseline and end line data to allow for comparison. – Comparison of baseline and end line; Intervention and Control with regard to • Complementary feeding practices (Frequency, Amount and Dietary diversity) • Maternal nutritional knowledge • Nutrient intake • Nutritional status of children • Determine if nutritional knowledge of the mothers has an effect on practice – Perform further statistical analysis
- 25. Acknowledgement • FederalMinistry of Economic Cooperation and Development, Germany and the CGIAR Research Programme on Agriculture for Nutrition and Health(A4NH) for funding • Supervisors – Prof Judith Kimiywe – Dr. Gudrun Keding • Bioversity International • Study participants • INULA colleagues
- 26.
Editor's Notes
- #3 DIVIDER SLIDE You can use it to introduce a section of your presentation.
- #4 Prevalence of malnutrition in Western Kenya: 34.2% of children in Western Kenya are stunted 12% of women 15-49 years are underweight (BMI< 18.5) while 25% are overweight or obese On determinants – mention studies Socio-economic status had an effect on nutritional status in a study in Bangladesh. Low level of education, poor economic status were associated with poor dietary intake in Tanzania
- #5 Prevalence of malnutrition in Western Kenya: 34.2% of children in Western Kenya are stunted 12% of women 15-49 years are underweight (BMI< 18.5) while 25% are overweight or obese On determinants – mention studies Socio-economic status had an effect on nutritional status in a study in Bangladesh. Low level of education, poor economic status were associated with poor dietary intake in Tanzania
- #8 DIVIDER SLIDE You can use it to introduce a section of your presentation.
- #9 LM1=Humid Lower Midland Zone LM2= Sub-humid Lower Midland Zone LM3= Semi-humid Lower Midland Zone LM4= Transitional Lower Midland Zone UM1= Humid Upper Midland Zone
- #14 Dietary Diversity Questionnaire used to collect data on HHDS,WDDS, CDDS Dietary diversity scores is the sum of food groups consumed over a 24 hour reference period
- #17 DIVIDER SLIDE You can use it to introduce a section of your presentation.
- #18 Minimum and max age of mother – 16 and 65 Minimum and mac age of child – 5.3 – 23.8 A high percentage of mother had only primary school level education.
- #20 Minimum and max age of mother – 16 and 65 Minimum and mac age of child – 5.3 – 23.8 A high percentage of mother had only primary school level education.
- #24 DIVIDER SLIDE You can use it to introduce a section of your presentation.
- #25 TEXT + 2 PICTURES AT THE BOTTOM
- #26 TEXT + 2 PICTURES AT THE BOTTOM
- #27 TEXT + 2 PICTURES AT THE BOTTOM
- #29 THANK YOU/FINAL SLIDE