Improvements In Complementary Foods

In Ethiopia By Adding Pulses:

Effect On Mothers’ Practices And

Children’s Nutritional Status

S.J. Whiting, C.J. Henry, C. Negash,

D. Mulualem, A. Kebebu

University of Saskatchewan and Hawassa University

Background

• The first 1000 days of life are critical to a child’s

current and future health.

– Included is complementary feeding for infants and young

children (IYC) age 6 - 24 mo.

• Nutritious CF is needed in countries where under-

nutrition and stunting are major problems

– Caregivers may be reluctant to change from traditional

cereal-based gruels

• The aim of our work has been to conduct recipe-based

nutrition education intervention on promoting pulses in

complementary feeding practices.

– Two acceptably and two intervention studies

2

Context

• In Ethiopia 44%, 29%

and 10% of children

under age five are

stunted, wasted and

underweight

respectively (CSA,

2012).

• CF is most often a

cereal-based gruel with

poor protein and

micronutrient content

3

Studies of Acceptability

of Pulses as CF

• In Ticheta southern Ethiopia, mothers indicated

they did not (would not) use pulses in CF

(Kebebu et al., 2013)

• Afework made broad bean, maize and barley

flours (including germination to reduce phytate)

to make porridge:

– Barley-maize

– Barley-maize-broad bean

• Sensory testing with mothers-children

was conducted as mothers believed

young children would not like pulses

4

Acceptance testing result of panelists of children and mothers at Titecha kebele

Children liked the pulses porridges as much as their usual maize-barley porridge

5

Control(no Bean)

10%Bean

20%Bean

30%Bean

Studies of nutrition education with recipe testing as interventions for CF

• Studies in other countries show the nutritional status of

children could be improved through recipe-based

nutrition education intervention (Bhandari et al., 2004;

Liaqat et al., 2007; Khan et al., 2013; Penny et al., 2005)

• In Ethiopia Alive and Thrive issued nutrition education

about CF to include pulses

• Face validity only

• Two studies:

– Negash et al. (submitted ) Ticheta (broad bean)

– Mulualem (completed 2014) Wolayita (haricot bean)

6

Alive and Thrive (Ethiopia) Training manual

7

Wolayita Study Objectives

To assess the effects of nutrition education on adding pulses in

complementary feeding practices in Wolayita Zone, southern

Ethiopia.

• To identify the KAP of mothers on the use of pulses in

complementary feeding before and after the intervention

– Recipe demonstration

– Used Health Belief Model (HBM)

• To compare the anthropometric measurements and indices

of young children prior and after the intervention

8

Design:

• Quasi-Experimental study: Control and Intervention

• Pretest-posttest and delayed post-test design

Study period: April to November 2013

Target population:Mothers who had young children age 6-18 mo residing in

Taba kebele (Intervention) and Gacheno kebele (Control)for at least 6 months

Sample size calculation: 80 per group

Exclusions: identical and/or fraternal twins

enrolled in any other nutrition program

were sick at the time of visiting

were taking drugs for any type of illness

had any apparent signs and symptoms of diseases such as fever and cough

9

10

Figure 1: flow diagram of the progress through the phase of

quasi-experimental study

Intervention:

Nutrition education was given only to the intervention

group using Health Belief Model (HBM) constructs.

4 groups of 20 mother-child pairs

Every two weeks for duration of two hours for six months

The educational strategies include: lesson education,

group discussion, demonstration, surprise home visit.

• Based on the Alive-Thrive complementary feeding training

manual (Alive-Thrive, 2012),

• 1/4 pulse + 3/4 cereal messages

• Essential nutrition action messages of complementary

feeding practices (8 key messages)

11

The 8 key complementary feeding messages conveyed to

mothers 12

Study participants during lesson education 13

Demonstrations:

• Procedural guidelines for

the preparation of pulse-

incorporated

complementary food

recipe were prepared

and used

• The recipe steps were

discussed, explained

and demonstrated to the

mothers

• Porridge was made in

sufficient quantity for

tasting

• Soap or salt was

provided at each session

14

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Results

Maternal and child characteristics:

There was no significant difference on the distribution of

sex (p=0.230) and age (p=0.851) of young children among

the intervention and control group (Table 1)

Table 1: Sex and pre-intervention age group of children

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Table: Baseline child feeding and caring practice

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Results

Comparison of mean KAP scores of mothers:

There were increases in mean KAP scores of mothers

in the intervention group throughout the study period

Attitude and practice scores similarly changed

Figure 9a : Comparison of mean knowledge scores

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Results

Mean (SD) anthropometric indices of young children by intervention group

and period

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Results

Mean (SD) anthropometric indices of young children by intervention group

and period

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Comparison of anthropometrics:

Figure 11a: Pre-intervention weight for age Z score of young children

Figure 11b: Post-intervention weight for age Z score of young children

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The intervention in this study demonstrated significant

change in:

• KAP of mothers related to pulse-incorporated

complementary feeding practices and

• Mean weight gain, WAZ, WHZ of young children.

=> These also found in Negash study

Strengths of Study

Continued lesson education sessions,

Interactive group discussions,

Repeated recipe demonstrations

Surprise home visiting and follow-ups during the

intervention period.

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Future Research and KT

• Work with NGOs and industry to promote pulse-containing CF

• Consider ways to have nutrition education on larger scale so it has interactive components (e.g, recipe, tasting)

23

awassa

Acknowledgements• CIFSRF TEAM (Carol henry PI)

• University of Saskatchewan

• Hawassa University

• Universities of Florida

• Women and their children