Effect of Counseling about Complementary Food Flour Soaking On Hemoglobin Level, Nutritional and Health Status of Children 6-23 Months in Agrarian Community of Bale Zone: A Quasi-Experimental Study

Abstract

The complementary feeding period (6–23 months) is a time when young children are most vulnerable to undernutrition and consequent growth faltering. During this period children experience dynamic growth and development and have high nutrient needs as a result rates of malnutrition usually peak with consequences that reverberate throughout life. The high risk of undernutrition in the first 2 years of life has been directly linked with poor complementary feeding practices. About 33-45% of deaths in children less than five years of age are due to underlying undernutrition, including stunting, wasting, and, micronutrient deficiencies. Complementary feeding is a critical component of infant and young child feeding practices (IYCF), and optimal complementary feeding practices have been demonstrated to prevent undernutrition and micronutrient deficiencies. Appropriate complementary feeding practices are required to provide the nutrient deficits of breastmilk among children six months and older for whom breastmilk alone is inadequate. As with other dietary guidelines, the World Health Organization and UNICEF’s Complementary feeding recommendations are geared towards halting and reducing the rate of nutrition-related morbidities resulting from inadequate intakes. Deriving from the broad principles of the joint WHO and UNICEF’s Global Strategy for Infant and Young Child Feeding developed, the government of Ethiopia is implementing different strategies aimed at improving IYCF practices through the implementation of infant and young child feeding guidelines across the country. However, these efforts failed to improve, child undernutrition in the country. As in other developing countries in Ethiopia still, child undernutrition is most prevalent among young children. In poor countries like Ethiopia during the complementary feeding period, children are often fed cereal-based diluted low-calorie porridge. This porridge may be high in antinutrients, low in energy and protein, and nutrient density hence inadequate in providing infants with high energy and nutrient requirements resulting in a high prevalence of undernutrition. Therefore, there is a need to develop an approach to control the limitations associated with locally formulated cereal-based complementary food in poor settings. We conducted a community-based Behavioural change intervention to evaluate the effectiveness of counseling about complementary food flour soaking on hemoglobin, nutritional and health status of children 6-23 months We examined the level and predictors of child undernutrition at baseline (before the intervention was delivered). The findings indicated the existence of ‘high’ levels of child undernutrition. About 14.5% (95% CI 12.05-17.04) of the children were wasted, 33.6% (95% CI 30.29-36.98) were stunted, and 12.2% (95% CI 9.89-14.53) were underweight. Likewise, the prevalence of anaemia xiii was 47.9% (95 % CI (44⋅4, 51⋅5)). On the multivariable logistic regression model, male children [AOR=2.03; 95%: (1.24-3.35)] and children born to mothers who did not receive postnatal care follow-up [AOR=3.26; 95%: (2.03-5.24)] were independent predictors of children wasting. Being Male [AOR=1.95; 95%: 1.40-2.71], living in household with two or more under-five children [AOR=1.64; 95%: 1.40-2.71], coming from rural area [AOR=1.83; 95%: 1.22-2.75], being in food insecure household [AOR=1.42; 95%: 1.02-1.98], having less than four dietary diversity score and being anemic [AOR=1.62; 95%: 1.16-2.27] increases the odds of being stunted. Male children [AOR=2.52; 95%: 1.27-5.02] and children whose mothers attended postnatal care service only once [AOR=3.06; 95%: 1.45-6.46] were significantly likely to be underweight. Likewise, child age (6–11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), children in the households with food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and being stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were more likely to be associated with anaemia. Based on the findings of the baseline study, a quasi-experimental study was conducted to investigate the effect of behavior change communication intervention about complementary food flour soaking delivered through community volunteers on hemoglobin, nutritional, and health status of children 6-23 months. It was observed that the intervention significantly improved the mean hemoglobin level by 0.15 (DID: 0.15: 95% CI: 0.095‒0.223), Weight-for-Age Z score of children by 0.30 (β=0.30, 95 % CI: 0.15 -0.45), and Weight -for- length Z score by 0.47 (β=0.47, 95 % CI: 0.25–0.69). However, the intervention did not improve Length-for- Age Z score and health status. In conclusion, findings from this PhD research showed that behavior changes communication intervention about complementary food flour soaking delivered through community volunteers improved nutritional outcomes and hemoglobin levels of young children. Chapter 7 presents the general discussion and implications, conclusions, and recommendations of the study.