Impact Evaluation of a Multi-Sectoral Community-Based Approach to Improving Infant and Young Child Feeding in Amhara, Ethiopia

Not Applicable

Completed

• Conditions: Exclusive Breastfeeding; Complementary Feeding
• Interventions: Behavioral: Mass media; Behavioral: A&T community-based interventions

• Registration Number: NCT02775552
• Lead Sponsor: International Food Policy Research Institute

Brief Summary

Alive \& Thrive is an initiative that aims to scale up nutrition to save lives, prevent illness, and ensure healthy growth and development through improved infant young child feeding (IYCF) practices. The purpose of this study is to evaluate whether the Alive \& Thrive intervention package, consisting of interpersonal communication, community mobilization activities, and radio campaign, can increase complementary feeding practices (minimum dietary diversity and minimum meal frequency) while sustaining exclusive breastfeeding rate among children less than two years of age. The impact evaluation uses a cluster-randomized design where 20 geographic clusters (woredas/districts) were randomized to two study arms - 10 intervention areas and 10 comparison areas. Repeated cross-sectional baseline and endline surveys will be used to assess program impact.

Detailed Description

In Amhara, the median duration of exclusive breastfeeding (4.6 months) is the highest among all the other regions in the country, but complementary feeding indicators lag behind (2% minimum dietary diversity and 34% minimum meal frequency). As a result, A\&T's program emphasis will be placed on increasing mothers' knowledge and skills to improve complementary feeding practices without compromising exclusive breastfeeding. Given the short duration of implementation, the goal is to show that it is possible to achieve behavior change related to IYCF through a multi-sector approach. The purpose of this study is to evaluate whether the Alive \& Thrive intervention package, consisting of interpersonal communication, community mobilization activities, and radio campaign, can increase select complementary feeding practices (minimum dietary diversity and minimum meal frequency increased by 10 percentage points) while sustaining exclusive breastfeeding rate among children less than two years of age.

A cluster randomized design with repeated cross-sectional surveys at baseline (2015) and endline (2017) is used to assess impact of the A\&T interventions in three western zones of Amhara, Ethiopia. In the three zones, 20 woredas (districts) were randomly assigned as 10 intervention and 10 comparison/control areas. A\&T intervention areas are expected to receive intensive IYCF social and behavior change communication activities as well as exposure to a region-wide radio campaign. In accordance with program objectives, sample sizes for the household survey were estimated to detect changes in the three main impact indicators - sustained exclusive breastfeeding, improved minimum dietary diversity, and improved minimum meal frequency. The estimated household sample sizes are 400 children 0-5.9 months old for exclusive breastfeeding in the A\&T intervention areas only and 1350 children 6-23.9 months old per study arm for complementary feeding practices, for a total sample size of 3100 children 0-23.9 months of age. Infant feeding practices will be assessed using before- and after- intervention-comparison area group differences between the baseline survey (March-April 2015) and endline survey (March-April 2017). In addition, surveys of frontline workers will help document their awareness and knowledge about IYCF, training, supervision, and delivery of interventions to beneficiary households.

Study Timeline

• Study Start: 2015-03
• Study First Submitted: 2016-05-12
• Study First Submitted QC: 2016-05-16
• Study First Posted: 2016-05-17
• Primary Completion: 2017-04
• Study Completion: 2017-04
• Status Verified: 2018-02
• Last Update Submitted: 2018-02-23
• Last Update Posted: 2018-02-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 3120

Inclusion Criteria

• Gives informed consent
• Being aged from 15 to 49 years (women of reproductive age)
• Has at least one infant less than 24 months old who is currently alive and lives with her

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Exclusion Criteria

Not provided

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Comparison areas	Mass media	(Receive standard government services)
A&T intervention areas	Mass media	-
A&T intervention areas	A&T community-based interventions	-

Primary Outcome Measures

Name	Time	Method
Minimum dietary diversity among children aged 6-23.9 months	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of children aged 6-23.9 months months who received foods from 4 or more food groups on the day preceding the interview.
Minimum meal frequency of (semi) solid or soft foods among children aged 6-23.9 months	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of children aged 6-23.9 months who received (semi) solid or soft foods the minimum number of times or more on the day preceding the interview.
Exclusive breastfeeding among children aged 0-5.9 months in the intervention areas only	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of infants aged less than 6 months who were exclusively breastfed on the day preceding the interview.

Secondary Outcome Measures

Name	Time	Method
Early initiation of breastfeeding among children aged 0-5.9 months in the intervention areas only and among children aged 6-23.9 months in intervention and comparison areas	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of children aged less than 24 months who were breastfed within 1 hour of birth.
Minimum acceptable diet among children aged 6-23.9 months	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of children aged 6-23.9 months who received a minimum acceptable diet (minimum dietary diversity and minimum meal frequency) on the day preceding the interview.
Mother's accurate knowledge of adequate child feeding practices	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	Proportion of mothers who report correct knowledge about breastfeeding and complementary feeding practices based on questionnaire
Continued breastfeeding at 1 year among children aged 12-15.9 months	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of children aged 12-15.9 months who were breastfed on the day preceding the interview.
Timely introduction of (semi) solid or soft foods among children aged 6-8.9 months	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of infants aged 6-8.9 months who received (semi) solid or soft foods on the day preceding the interview.
Consumption of iron-rich foods among children aged 6-23.9 months	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	The proportion of children aged 6-23.9 months who received an iron-rich or iron-fortified food on the day preceding the interview.
Mother's beliefs, self-efficacy, and perceptions of social norms about child feeding during fasting	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	Proportion of mothers who report positive beliefs, self-efficacy, and perceptions of social norms about feeding animal source foods to children and feeding as often as usual during fasting based on questionnaire
Nutritional status of children 6-23 months of age	2 years after baseline in a cross-sectional endline survey scheduled for March-April 2017	Prevalence of stunting, underweight and wasting among children 6-23 months

Trial Locations

Locations (1)

International Food Policy Research Institute; 🇪🇹 Addis Ababa, Ethiopia