title: Effectiveness of nutrition training of health workers toward improving caregivers' feeding practices for children aged six months to two years: a systematic review.
abstract: BACKGROUND
  Nutrition training of health workers can help to reduce child undernutrition. Specifically, trained health workers might contribute to this end through frequent nutrition counseling of caregivers. This may improve child-feeding practices and thus reduce the risk of undernutrition among children of counseled caregivers. Although studies have shown varied impacts of health workers' nutrition training on child feeding practices, no systematic review of the effectiveness of such intervention has yet been reported. Therefore, we conducted this study to examine the effectiveness of nutrition training for health workers on child feeding practices including feeding frequency, energy intake, and dietary diversity among children aged six months to two years.
  
  
  METHODS
  We searched the literature for published randomized controlled trials (RCTs) and cluster RCTs using medical databases including PubMed/MEDLINE, CINAHL, EMBASE, and ISI Web of Knowledge, and through WHO regional databases. Our intervention of interest was nutrition training of health workers. We pooled the results of the selected trials, evaluated them using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, and calculated the overall effect size of the intervention in meta-analyses.
  
  
  RESULTS
  Ten RCTs and cluster RCTs out of 4757 retrieved articles were eligible for final analyses. Overall, health workers' nutrition training improved daily energy intake of children between six months and two years of age. The pooled evidence from the three studies reporting mean energy intake per day revealed a standardized mean difference (SMD) of 0.76, 95% CI (0.63-0.88). For the two studies with median energy intake SMD was 1.06 (95% CI 0.87-1.24). Health workers' nutrition training also improved feeding frequency among children aged six months to two years. The pooled evidence from the three studies reporting mean feeding frequency showed an SMD of 0.48 (95% CI 0.38-0.58). Regarding dietary diversity, children in intervention groups were more likely to consume more diverse diets compared to their counterparts.
  
  
  CONCLUSIONS
  Nutrition training for health workers can improve feeding frequency, energy intake, and dietary diversity of children aged six months to two years. Scaling up of nutrition training for health workers presents a potential entry point to improve nutrition status among children.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Bruno F
authors.initials: BF
authors.lastname: Sunguya
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Poudel
authors.forename: Linda B
authors.initials: LB
authors.lastname: Mlunde
authors.forename: Prakash
authors.initials: P
authors.lastname: Shakya
authors.forename: David P
authors.initials: DP
authors.lastname: Urassa
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
mesh_terms: D017028:Caregivers / Q000193:education*; D002675:Child, Preschool; D003376:Counseling / Q000193:education; D016208:Databases, Factual; D002149:Energy Intake; D005247:Feeding Behavior; D006801:Humans; D007223:Infant; D009752:Nutritional Status; D016032:Randomized Controlled Trials as Topic