title: Effectiveness of a community-based nutrition programme to improve child growth in rural Ethiopia: a cluster randomized trial.
abstract: Few trials have shown that promoting complementary feeding among young children is effective in improving child linear growth in resource-challenged settings. We designed a community-based participatory nutrition promotion (CPNP) programme adapting a Positive Deviance/Hearth approach that engaged mothers in 2-week nutrition sessions using the principles of 'learning by doing' around child feeding. We aimed to test the effectiveness of the CPNP for improving child growth in rural Ethiopia. A cluster randomized trial was implemented by adding the CPNP to the existing government nutrition programmes (six clusters) vs. government programmes only (six clusters). A total of 1790 children aged 6 to 12 months (876 in the intervention and 914 in the control areas) were enrolled and assessed on anthropometry every 3 months for a year. Multi-level mixed-effect regression analysis of longitudinal outcome data (n = 1475) examined the programme impact on growth, adjusting for clustering and enrollment characteristics. Compared with children 6 to 24 months of age in the control area, those in the intervention area had a greater increase in z scores for length-for-age [difference (diff): 0.021 z score/month, 95% CI: 0.008, 0.034] and weight-for-length (diff: 0.042 z score/month, 95% CI: 0.024, 0.059). At the end of the 12-month follow-up, children in the intervention area showed an 8.1% (P = 0.02) and 6.3% (P = 0.046) lower prevalence of stunting and underweight, respectively, after controlling for differences in the prevalence at enrollment, compared with the control group. A novel CPNP programme was effective in improving child growth and reducing undernutrition in this setting. © 2016 John Wiley & Sons Ltd.
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Yunhee
authors.initials: Y
authors.lastname: Kang
authors.affiliation: International Ministry Division, World Vision Korea, Seoul, Korea.
authors.forename: Sungtae
authors.initials: S
authors.lastname: Kim
authors.affiliation: East Africa Regional Office, World Vision International, Addis Ababa, Ethiopia.
authors.forename: Sisay
authors.initials: S
authors.lastname: Sinamo
authors.affiliation: Global Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
mesh_terms: D000328:Adult; D000886:Anthropometry; D002657:Child Development; D002675:Child, Preschool; D016000:Cluster Analysis; D055812:Community-Based Participatory Research; D005002:Ethiopia; D005260:Female; D006130:Growth Disorders / Q000178:diet therapy / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D009035:Mothers; D009752:Nutritional Status; D015995:Prevalence; D012424:Rural Population; D012959:Socioeconomic Factors; D013851:Thinness / Q000178:diet therapy / Q000517:prevention & control*; D055815:Young Adult
keywords: Ethiopia; childhood stunting; cluster randomized trial; community-based participatory nutrition promotion; complementary feeding practices; effectiveness evaluation