An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone

Bridget A Aidam; Carolyn A MacDonald; Rebecca Wee; Joseph Simba; Judi Aubel; Kathryn R Reinsma; Amy Webb Girard

doi:10.1093/cdn/nzaa174

An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone

Curr Dev Nutr. 2020 Nov 30;4(12):nzaa174. doi: 10.1093/cdn/nzaa174. eCollection 2020 Dec.

Authors

Bridget A Aidam¹, Carolyn A MacDonald², Rebecca Wee³, Joseph Simba⁴, Judi Aubel⁵, Kathryn R Reinsma², Amy Webb Girard³

Affiliations

¹ Action Against Hunger USA. Previously of Evidence and Learning Unit, World Vision International, Washington, DC, USA.
² World Vision International, Nutrition Centre of Expertise, Mississauga, Ontario, Canada.
³ Hubert Department of Global Health and Nutrition, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁴ World Vision Sierra Leone, Freetown, Sierra Leone.
⁵ Grandmother Project: Change through Culture, Rome, Italy.

Abstract

Background: Suboptimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition; however, in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated.

Objectives: We examined how an innovative grandmother-inclusive approach (GMIA) can be used to address suboptimal IYCF practices.

Methods: Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children aged <2 y, and 219 grandmothers. Statistical analyses utilized t tests and χ² tests to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest.

Results: Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children aged 0-23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% compared with 79.4%, P = 0.01). Among infants aged 6-23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% compared with 51.8%, P < 0.001; and 53.8% compared with 22.6%, P < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants aged 9-23 mo, with the intervention group achieving a higher MMF (54.6% compared with 36.9%, P = 0.02).

Conclusions: Results suggest that a GMIA that recognizes grandmothers' roles and strengthens their knowledge can contribute to improved IYCF practices.

Keywords: Grandmother Inclusive Approach; behavior change communication; breastfeeding; diet diversity; grandmothers; infant and young child feeding; innovation.