Peer Support Groups Improve Infant Growth and Complementary Feeding Practices Among Refugees in Post-emergency Settlements in the West- Nile Region in Uganda
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 390
- 试验地点
- 2
- 主要终点
- Infant minimum acceptable diet (MAD)
研究概览
简要总结
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.
详细描述
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:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Double (Participant, Outcomes Assessor)
盲法说明
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.
入排标准
- 年龄范围
- 15 Years 至 49 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •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
排除标准
- •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.
结局指标
主要结局
Infant minimum acceptable diet (MAD)
时间窗: through study completion, an average of 1 year
Proportions of infants who met composite indicator of optimal age specific frequency of meals and the adequate variety i.e. * Breastfed infants in the 6 - 23 months age range with adequate minimum dietary diversity and meal frequency in the past 24 hours * Non-breastfed infants within 6 - 23 months with adequate minimum dietary diversity and meal frequency in the past 24 hours in addition to at least two milk feeds
Eggs and or flesh foods consumption (EFF)
时间窗: through study completion, an average of 1 year
Proportion of infants between 6 - 23 months who consumed an egg or flesh foods in the previous day.
infant stunting
时间窗: through study completion, an average of 1 year
Length-for-age z-scores (LAZ)(The z-scores were calculated after subtracting the measured length of a child from the median value of the reference population and adjusted for sex and age). A cutoff of - 2 z-score indicates stunting.
infant underweight
时间窗: through study completion, an average of 1 year
Weight-for-age z-scores (WAZ)(The z-scores were calculated after subtracting the measured weight of a child from the median value of the reference population and adjusted for sex and age). A cutoff of - 2 z-score indicates underweight.
Introduction of solid and semi-solid or soft foods (ISSSF)
时间窗: through study completion, an average of 1 year
Proportion of infants introduced to solid, semi-solid or soft foods at 6 months, continually breastfed and were between 6 - 8 months of age
Infant minimum dietary diversity scores (MDD)
时间窗: through study completion, an average of 1 year
Proportion of infants in the age category 6 - 23 months who consumed at least five food groups of the recommended eight in the past 24 hours. The food groups include - currently breastfed; roots and tubers; grains; flesh foods (meat, fish, poultry, and organ meats); legumes and nuts; dairy products; vitamin A-rich fruits and vegetables; eggs; other fruits and vegetables
Infant minimum meal frequency (MMF)
时间窗: through study completion, an average of 1 year
Proportion of infants in the age category 6 - 23 months who consumed solid, semi-solid or soft foods including snacks the recommended minimum number of times for both breastfed and non-breastfed infants. That is, a minimum of * 2 feedings for breastfed infants 6 - 8 months of age * 3 feedings for breastfed infants in the 9 - 23 months of age category * 4 feeding for non-breastfed infants in 6 - 23 months age category.
infant wasting
时间窗: through study completion, an average of 1 year
Weight-for-length z-scores (WAZ)(The z-scores were calculated after subtracting the measured length and weight of a child from the median value of the reference population and adjusted for sex and age). A cutoff of - 2 z-score indicates wasting.
次要结局
- Maternal social support(through study completion, an average of 1 year)
研究者
Joel Komakech
Principal Investigator
Oklahoma State University