K. K. Saha
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K. K. Saha 1 ; R. Rawat 2 ; A. Khaled 1 ; R. Haque 3 ; K. Afsana 3 ; T. G. Sanghvi 4 ; M. T. Ruel 2 ; P. Menon 5

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PO1520

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Po1520

K. K. Saha1; R. Rawat2; A. Khaled1; R. Haque3; K. Afsana3; T. G. Sanghvi4; M. T. Ruel2; P. Menon5

1International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh; 2IFPRI, Washington DC,USA; 3BRAC, Dhaka, Bangladesh, 4FHI360, Dhaka, Bangladesh; 5IFPRI, New Delhi, India

Background and Objectives:

  • Alive & Thrive (A&T) is a 6-year initiative (2009-2013) to improve infant and young child nutrition. This initiative works in 3 countries - Bangladesh, Ethiopia, and Vietnam.

  • The overall goal of A&T initiative in each country is to increase rates of exclusive breastfeeding in the first 6 months of life and reduce childhood stunting by improving infant and young child feeding (IYCF).

  • In Bangladesh, A&T initiative aims to improve IYCF practices of mothers through intensive counseling by skilled frontline health workers (FHWs) and a mass media campaign. Well-trained and supervised FHWs counseled mothers of children 0-24 months of age on IYCF through regular home visits – 6 visits between 0-6 months and 6 between 7-24 months. We studied the early impacts of the intervention on mothers’ IYCF knowledge and practices.

INTENSIVE COUNSELING BY HEALTH WORKERS IMPROVED INFANT AND YOUNG CHILD FEEDING KNOWLEDGE AND PRACTICES IN A LARGE-SCALE PROGRAM IN BANGLADESH

Methods:

  • In 2012, we conducted a program theory-driven process evaluation using a cluster-randomized design comparing A&T intensive and A&T non-intensive interventions (5 sub-districts in each group) after 2 years of implementation.

  • A&T intensive areas received BCC counseling by FHW and a mass media campaign; A&T Non-intensive areas received only mass media campaign.

  • Exposure to FHW and TV commercials (TVCs) on 6 IYCF themes were measured using aided recall method. A mother was shown a picture of a FHW and was asked if that FHW visited her house and gave advice on IYCF. Similarly, a mother was shown a series of still pictures on each TVC and was asked if she saw that TVC on the TV. If yes, she was asked to tell about the story told in the TVC.

  • IYCF practices were constructed following the WHO recommended indicators of IYCF.

  • IYCF knowledge and practices for mothers of children 6-24 months were compared between groups.

Results:

Figure 2: Core WHO indicators of IYCF

Figure 1: Age of introduction of different foods in A&T intensive and A&T non-intensive areas

**

* p < 0.05, ** p < 0.01, *** p < 0.001

* p < 0.05, ** p < 0.01, *** p < 0.001

  • At baseline, mother’s IYCF knowledge and practices were inadequate; no difference between the two areas.

  • In 2012, HH visits were significantly higher in A&T intensive areas. There were more frequent visits and more time spent at home by FHWs in A&T areas.

  • About 25-50% of the mothers were able to recall the TVCs and these were similar in both areas.

  • In 2012, maternal knowledge about breastfeeding (initiation and continuation) and complementary feeding (timing of introduction, frequency and quantity) were greater in A&T intensive compared to A&T non-intensive areas.

  • In 2012, feeding of iron rich foods (66% vs. 42%) and minimum dietary diversity (52% vs. 34%) were higher (p<0.05) in A&T intensive areas.

Conclusions:

  • After 2 years of program implementation, mothers who received both FHW counseling and mass media had significantly better CF practices than those who were exposed to mass media only.

  • It is feasible to integrate IYCF counseling by skilled FHWs into a large-scale health program and thereby improve mothers’ IYCF knowledge and practices.

Keywords:

IYCF knowledge, IYCF practices, frontline health workers, Alive & Thrive, Bangladesh.

Funding: Bill and Melinda Gates Foundation, through Alive & Thrive, managed by FHI360.

PO1520


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