The effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt.
BACKGROUND
The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC).


OBJECTIVE
To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth.


METHODS
A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length.


RESULTS
CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004).


CONCLUSIONS
Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.
Departments of aPediatrics bFamily Medicine, Faculty of Medicine, Suez Canal University, Ismailia cMinistry of Health and Population, Cairo, Egypt dDepartment of Child and Adolescent Health and Development, World Health Organization (WHO), Geneva, Switzerland.
Hesham
H
El-Sayed
Jose
J
Martines
Mona
M
Rakha
Osama
O
Zekry
Mona
M
Abdel-Hak
Hanan
H
Abbas
D000886:Anthropometry; D001291:Attitude of Health Personnel; D001942:Breast Feeding; D053198:Child Nutrition Sciences / Q000193:education*; D003376:Counseling / Q000379:methods*; D004534:Egypt; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D009035:Mothers / Q000523:psychology*; D010820:Physicians; D011320:Primary Health Care / Q000379:methods*; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D015430:Weight Gain; D014944:World Health Organization