title: Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh.
abstract: This prospective randomized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practices, care-giving, and health-seeking practices under the Bangladesh Integrated Nutrition Project (BINP). The study was conducted in rural Bangladesh among 282 moderately-malnourished (weight-for-age between 61% and 75% of median of the National Center for Health Statistics standard) children aged 6-24 months. Mothers of the first intervention group received intensive nutrition education (INE group) twice a week for three months. The second intervention group received the same nutrition education, and their children received additional supplementary feeding (INE+SF group). The comparison group received nutrition education from the community nutrition promoters twice a month according to the standard routine service of BINP. The children were observed for a further six months. After three months of interventions, a significantly higher proportion of children in the INE and INE+SF groups improved (37% and 47% respectively) from moderate to mild or normal nutrition compared to the comparison group (18%) (p < 0.001). At the end of six months of observation, the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group (59% and 86% vs 30%, p < 0.0001). As the intensive nutrition education and supplementation given were highly effective, more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity. The frequency of child feeding and home-based complementary feeding improved significantly (p < 0.001) in both the intervention groups after three months of interventions and six months of observation. Body-weight gain was positively associated with age, length-for-age, weight-for-length, frequency of feeding of khichuri, egg, and potato (p < 0.05). Ability of mothers to identify malnutrition improved from 15% to 99% in the INE group and from 15% to 100% in the INE+SF group, but reduced from 24% to 21% in the comparison group. Use of separate feed pots, frequency of feeding, and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation. It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding.
authors.affiliation: Clinical Sciences Division, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh. skroy@icddrb.org
authors.forename: S K
authors.initials: SK
authors.lastname: Roy
authors.forename: G J
authors.initials: GJ
authors.lastname: Fuchs
authors.forename: Zeba
authors.initials: Z
authors.lastname: Mahmud
authors.forename: Gulshan
authors.initials: G
authors.lastname: Ara
authors.forename: Sumaya
authors.initials: S
authors.lastname: Islam
authors.forename: Sohana
authors.initials: S
authors.lastname: Shafique
authors.forename: Syeda Sharmin
authors.initials: SS
authors.lastname: Akter
authors.forename: Barnali
authors.initials: B
authors.lastname: Chakraborty
mesh_terms: D000704:Analysis of Variance; D001459:Bangladesh / Q000453:epidemiology; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control; D053198:Child Nutrition Sciences / Q000193:education; D002675:Child, Preschool; D005260:Female; D005527:Food, Fortified / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D009035:Mothers / Q000193:education*; D052756:Nutritional Sciences / Q000193:education*; D009752:Nutritional Status / Q000502:physiology*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome