title: A Nutrition Education Program in Rural Bangladesh Was Associated with Improved Feeding Practices but Not with Child Growth.
abstract: Background:Childhood undernutrition is a major public health problem in Bangladesh. Evaluating child nutrition programs is a priority.Objective:The objective of this study was to evaluate a community-based nutrition education program (implemented from 2011 to 2013) aimed at improving infant and young child feeding (IYCF) practices and growth in rural Bangladesh.Methods:A cohort-based evaluation was conducted that included 2400 women (1200 from Karimganj, the intervention subdistrict, and 1200 from Katiadi, the control subdistrict) enrolled at 28-31 wk gestation in 3 waves between January and October 2011. Follow-up occurred at 3, 9, 16, and 24 mo of offspring age. The main outcomes were exclusive breastfeeding (EBF), measured at 3 mo, timing of complementary feeding (CF) initiation and minimum acceptable diet (MAD), measured at 9 mo, and child growth [assessed via length-for-agezscore (LAZ) and weight-for-lengthzscore], measured at all follow-ups. The main exposures were subdistrict of residence and wave of enrollment. For IYCF practices as outcome, logistic regressions were used. Generalized estimating equations were used for child growth as outcome.Results:EBF rates at 3 mo remained unchanged between waves 1 and 3 in Karimganj (55.6% compared with 57.3%), but the proportion of infants receiving timely CF initiation and MAD at 9 mo increased significantly (CF: 27.1-54.7%; MAD: 8.4-35.3%). Mean LAZ at 24 mo remained unchanged between waves 1 and 3 in Karimganj (-2.18 compared with -1.98).Conclusions:The program was successful in improving the quality of infant diet at 9 mo and timely CF initiation, but not EBF at 3 mo or LAZ. These findings support the case for implementing simple messages in all programs aimed at improving infant diet, especially in settings in which supplementing overall household diet may not be feasible.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health and Laney Graduate School.
authors.forename: Aatekah
authors.initials: A
authors.lastname: Owais
authors.affiliation: Los Angeles County Department of Public Health, Los Angeles, CA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schwartz
authors.affiliation: Department of Epidemiology, and.
authors.forename: David G
authors.initials: DG
authors.lastname: Kleinbaum
authors.affiliation: Hubert Department of Global Health, Emory University, Atlanta, GA.
authors.forename: Parminder S
authors.initials: PS
authors.lastname: Suchdev
authors.affiliation: International Center for Diarrheal Disease Research, Dhaka, Bangladesh; and.
authors.forename: Abu Syed Golam
authors.initials: ASG
authors.lastname: Faruque
authors.affiliation: International Center for Diarrheal Disease Research, Dhaka, Bangladesh; and.
authors.forename: Sumon K
authors.initials: SK
authors.lastname: Das
authors.affiliation: CARE Bangladesh, Dhaka, Bangladesh.
authors.forename: Shahed
authors.initials: S
authors.lastname: Rahman
authors.affiliation: Department of Epidemiology, and aryeh.stein@emory.edu.|Hubert Department of Global Health, Emory University, Atlanta, GA.
authors.forename: Aryeh D
authors.identifier: 0000-0003-1138-6458
authors.initials: AD
authors.lastname: Stein
mesh_terms: D000328:Adult; D001459:Bangladesh; D001827:Body Height; D001942:Breast Feeding; D015362:Child Nutrition Disorders / Q000517:prevention & control; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D005247:Feeding Behavior; D006266:Health Education; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D044342:Malnutrition / Q000517:prevention & control; D009035:Mothers; D009752:Nutritional Status; D015397:Program Evaluation; D012424:Rural Population; D015430:Weight Gain; D055815:Young Adult
keywords: child growth; cohort-based evaluation; community-based nutrition program; infant and young child feeding; rural Bangladesh