Peer Support Groups Improve Infant Growth and Complementary Feeding Practices Among Refugees in Post-emergency Settlements in the West- Nile Region in Uganda

Oklahoma State University1 site in 1 country390 target enrollmentStarted: January 9, 2020Last updated: October 18, 2022

Conditions

Interventions

Trial Snapshot

Phase: Not Applicable
Status: Completed
Sponsor: Oklahoma State University
Enrollment: 390
Locations: 1
Primary Endpoint: Eggs and or flesh foods consumption (EFF)

Study Overview Study Design Eligibility Criteria Arms & Interventions Outcomes Investigators Sites Records & Identifiers Similar Trials

Study Overview

Brief Summary

The goal of this randomized trial was to examine whether a peer-to-peer integrated intervention using Care Groups combining nutrition education and social support will improve infant growth and complementary feeding practices among refugees in the West-Nile region in Uganda. The aims of the study were to 1) determine the relationship of the intervention using the Care Group model on complementary feeding of infants, and 2) investigate the effects of a peer-led integrated nutrition education intervention using the Care Group model on growth among infants of refugees in Uganda.

Pregnant mothers (390) in their 3rd trimester were enrolled in a peer-led nutrition education intervention using the Care Group model. One treatment arm had moms only in the Care Groups while the other treatment arm had both moms and dads in the groups. Each study arm had a total of 10 Care Groups with 10-20 participants each. The control arm equally had 10 groups, however, did not receive the intervention. Each of the treatment arms participated in a biweekly integrated nutrition training hypothesized to effect behavioral change in infant feeding practices. The biweekly training started in March 2022 and ended in December 2022 with data collection at four-time points during the study (baseline, midline-I, II, and endline). Infant complementary feeding was evaluated using the World Health Organization & UNICEF guidelines. Infant growth was assessed using length-for-age z-scores, weight-for-age z-scores and weight-for-length z-scores. The Medical Outcomes Study (MOS) Social Support Index was used as a proxy to measure maternal social support. Effects of Care Group intervention on infant complementary feeding and growth were tested by study arm compared to the control arm.

Detailed Description

Brief introduction:

Low-and middle-income countries (LMICs) are "home" to most of the world's refugees, the majority of whom are women and children. Refugee children are vulnerable to undernutrition and poor health, and humanitarian agencies have highlighted child undernutrition as a key area for intervention during refugee situations. Complementary feeding of infants in refugee settlements remains inadequate; however, there is limited evidence on how to address these nutritional challenges in refugee settlements. In 2020, I conducted a year-long community-based randomized control trial among post-emergency settlements in the West Nile region in Uganda to examine whether an integrated nutrition education intervention delivered through Care Groups would improve infant feeding practices and growth in the post-emergency settlements in Uganda. The findings in this study may be used to design nutrition-sensitive programs and also inform policies targeting complementary feeding practices within post-emergency settlements in Uganda.

Study area:

The Adjumani district had been randomly selected among six districts and one city hosting refugees in the West Nile region. Initially, three settlements in the Adjumani district were randomly selected and assigned to the three arms of the study. Ayilo-I settlement was assigned as a Moms-only treatment arm, Pagirinya settlement was the Moms & Dads treatment arm while Nyumanzi settlement was the Control arm. During the recruitment of the participants, some fathers in the settlement (Pagirinya) assigned to the Moms & Dads treatment could not commit to participating in a year-long study because they had to move away from the settlement for jobs back to Juba, the capital of Sudan or nearby towns with more employment opportunities. Because of the limited number of participants in the Moms & Dads arm, a second randomization was done excluding the already selected settlements. Ayilo II was then selected as the other settlement to identify respondents for the Moms & Dads treatment arm. These settlements were at least six kilometers apart to reduce the possibility of spillover effects of the intervention. The village health team (VHTs) and health center midwife assistants supported the identification of pregnant mothers to be included in the study.

Sample size:

Study Design

Study Type: Interventional
Allocation: Randomized
Intervention Model: Parallel
Primary Purpose: Other
Masking: Double (Participant, Outcomes Assessor)

Masking Description

The settlements that were assigned to the different study arms were at least 6 kilometers apart to reduce the possibility of spillover effects of the intervention. The participants in each study arm were blinded from 1) which other settlements were involved in the activities they were engaging in and 2) what activities were and who was involved in those activities within the other study arms. Data collectors/enumerators were blinded from the study arm assignment.

Eligibility Criteria

Ages: 15 Years to 49 Years (Child, Adult)
Sex: All
Accepts Healthy Volunteers: Yes

Inclusion Criteria

•Pregnant women of reproductive age (15 - 49 years) in their third trimester were eligible to participate in the study.
•Husbands were eligible to participate with their wives in the Moms & Dads treatment arm

Exclusion Criteria

•Mothers whose antenatal records showed pregnancy complications were excluded from the study.
•Mothers who gave birth to premature infants, infants with congenital abnormalities, or whose infants died had the option of remaining in the study but were excluded from the final analyses.

Arms & Interventions

Moms-only treatment arm

Experimental

In this treatment arm, 10 Care Groups comprised of only mothers (10 - 20 participants per group) engaged in the peer-led intervention that consisted of infant feeding guidelines [16], cooking demonstrations, and backyard farming demonstrations conducted over 10 months. The peer-led trainings lasted 60 - 90 minutes and were conducted every two weeks and supervised by a selected VHT.

Intervention: Peer-led integrated nutrition education intervention delivered through Care Groups (Behavioral)

Moms and Dads treatment arm

Experimental

This treatment arm received a similar peer-led intervention to the Moms-only treatment arm, however, this arm comprised both moms and dads (a couple)

Intervention: Peer-led integrated nutrition education intervention delivered through Care Groups (Behavioral)

Control arm

No Intervention

This was the comparison arm of the study. No intervention was provided to the participants of this arm. However, all study arm participants accessed the standard of care which was the routine health services delivered through the government health centers.