Effect of Timed and Targeted Counseling in Changing IYCF Practices in Ethiopia

1. Mesfin Beyero MD MPH1, Kathryn Reider MS2, Yared Mekonnen PhD3 1World Vision Ethiopia, Addis Ababa, Ethiopia; 2World Vision U.S., Washington, DC; 3Mela Research PLC, Addis Ababa, Ethiopia Research support provided by FHI 360 through the Bill & Melinda Gates Foundation-funded Alive & Thrive project Background and Objectives: The nutrition program in Ethiopia has long focused on therapeutic interventions, particularly in response to acute malnutrition resulting from widespread food insecurity. Improving food security has led a shift in focus to prevention efforts and promotion of healthy growth, particularly to address stunting. Such efforts also shift the focus to households, where infant and young child feeding (IYCF) demands and practices occur. The overall objectiveof this project was to determine an effective and feasible way of delivering IYCF counseling leading to improved IYCF outcomes and reduced stunting in food secure areas of rural Ethiopia. Specific aims were to test the effectiveness of the Timed and Targeted Counseling (ttC) model in selected food secure areas and how counseling could be effectively and feasibly delivered through peer mothers, relieving Health Extension Workers (HEWs) of time constraints. Effect of Timed and TargetedCounseling in Changing IYCF Practices in Ethiopia Methods: Intervention: The intervention delivered IYCF counseling over a two-year period through “peer” mothers, who are available and willing to carry out household visits and counseling. The intervention used the Timed and Targeted Counseling approach and methodology, which delivers sets of “timed” messages related to a range of health and nutrition practices to households through scheduled visits that take place at pre-determined times during pregnancy and the first two years of the life of the child. Study design: The evaluation used a quasi-experimental study design in four implementation and four control districts in SNNPR Study participants: 800 mothers and caretakers of 1,600 young children from birth to 23.9 months old Survey indicators: Feeding practices, child nutrition, maternal health, food insecurity, child health, availability of services, women’s decision making Results: • The endline survey carried out after two years of implementation showed statistically significant improvements in breastfeeding-related behaviors, however, complementary feeding practice increases were not significant and could not be attributed to the intervention. Conclusions: Findings of this evaluation, taken together, demonstrated that the overall goals of the project intervention using the ttC approach were largely met. Women's knowledge and implementation of key IYCF practices significantly improved in the intervention area beyond what could have occurred in the rapidly changing environment attributed largely to the health extension program. This evaluation has also illuminated some gaps and challenges. First, coverage with ttC is moderate (46%), and about 54% of women with children 0-23 months old in the intervention area did not receive a ttC visit and can represent a missed opportunity for ttC. Second, the frequency of the visits were much lower than expected, and dropout from the first (during third trimester) to the 12th month (after delivery) visits was about 15% (absolute change). As a result, it is likely that this study did not show the maximum possible impact of the intervention. Indeed, had the ttC visit coverage been higher and more frequent, there likely would have been a much more vivid impact of the program interventions. Key Words: Infant and young child feeding, breast feeding, complementary feeding, counseling, Ethiopia PO0769