title: Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers.
abstract: Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster-randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home-visits would increase children's dietary intake, growth and development compared with home-visit-complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother-infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi-weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12-month intervention to the CFG and RCF&PG significantly (P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0-0.4] in the CFG (but not RCF&PG) and increased (P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8-5.3) in the RCF&PG (but not CFG) compared with CG. Community-based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food-secure rural Indian families.
authors.affiliation: Behavioral Sciences Unit of Field Studies, National Institute of Nutrition (ICMR), Hyderabad, India. s_vazir@hotmail.com
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Vazir
authors.forename: Patrice
authors.initials: P
authors.lastname: Engle
authors.forename: Nagalla
authors.initials: N
authors.lastname: Balakrishna
authors.forename: Paula L
authors.initials: PL
authors.lastname: Griffiths
authors.forename: Susan L
authors.initials: SL
authors.lastname: Johnson
authors.forename: Hilary
authors.initials: H
authors.lastname: Creed-Kanashiro
authors.forename: Sylvia
authors.initials: S
authors.lastname: Fernandez Rao
authors.forename: Monal R
authors.initials: MR
authors.lastname: Shroff
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Bentley
mesh_terms: D001942:Breast Feeding; D002657:Child Development; D053198:Child Nutrition Sciences / Q000193:education*; D016000:Cluster Analysis; D003152:Community Health Nursing; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn / Q000254:growth & development; D008297:Male; D009034:Mother-Child Relations; D009035:Mothers / Q000193:education* / Q000523:psychology*; D012959:Socioeconomic Factors; D014886:Weaning; D055815:Young Adult