A Peer-Led Integrated Nutrition Education Intervention through Care Groups Improved Complementary Feeding of Infants in Postemergency Settlements in the West-Nile Region in Uganda: A Cluster Randomized Trial

Joel J Komakech; Sam R Emerson; Ki L Cole; Christine N Walters; Hasina Rakotomanana; Margaret K Kabahenda; Deana A Hildebrand; Barbara J Stoecker

doi:10.1016/j.cdnut.2023.100042

A Peer-Led Integrated Nutrition Education Intervention through Care Groups Improved Complementary Feeding of Infants in Postemergency Settlements in the West-Nile Region in Uganda: A Cluster Randomized Trial

Curr Dev Nutr. 2023 Feb 3;7(3):100042. doi: 10.1016/j.cdnut.2023.100042. eCollection 2023 Mar.

Authors

Joel J Komakech¹, Sam R Emerson², Ki L Cole³, Christine N Walters⁴, Hasina Rakotomanana⁵, Margaret K Kabahenda⁶, Deana A Hildebrand², Barbara J Stoecker²

Affiliations

¹ Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, United States.
² Department of Nutritional Sciences, Oklahoma State University, United States.
³ Research, Evaluation, Measurement, and Statistics Department, Oklahoma State University, United States.
⁴ Science Department, Oklahoma State University-Oklahoma City, United States.
⁵ Nutrition Division, World Food Programme, Rome, Italy.
⁶ Department of Food Technology and Nutrition, Makerere University, Kampala, Uganda.

Abstract

Background: Complementary feeding of infants in refugee settlements remains inadequate. Furthermore, there has been limited evaluation of interventions addressing these nutrition challenges.

Objective: This study examined the effects of a peer-led integrated nutrition education intervention on infant complementary feeding by South Sudanese refugee mothers in the West-Nile region in Uganda.

Methods: A community-based randomized trial enrolled 390 pregnant women (during third trimester) as the baseline. Two arms [mothers-only and parents-combined (both mothers and fathers)] comprised treatments with a control. Infant feeding was assessed using WHO and UNICEF guidelines. Data were collected at Midline-II and Endline. The medical outcomes study (MOS) social support index was used to measure social support. An overall mean score of >4 was considered optimal social support, a score of ≤2 was none or little support. Adjusted multivariable logistic regression models determined the effects of the intervention on infant complementary feeding.

Results: At the end of the study, infant complementary feeding improved significantly in both mothers-only and parents-combined arms. There was a positive effect on the introduction of solid, semisolid, and soft foods (ISSSF) in the mothers-only arm at both Midline-II {adjusted odds ratio (AOR) = 4.0]} and Endline (AOR = 3.8). Likewise, ISSSF was better for the parents-combined arm at both Midline-II (AOR = 4.5) and Endline (AOR = 3.4). Minimum dietary diversity (MDD) was significantly better at the Endline for the parents-combined arm (AOR = 3.0). Minimum acceptable diet (MAD) was significantly better at Endline for both mothers-only (AOR = 2.3) and parents-combined arms (AOR = 2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the parents-combined arm at both Midline-II (AOR = 3.3) and Endline (AOR = 2.4). Higher maternal social support was associated with better infant MDD (AOR = 3.3), MAD (AOR = 3.6), and EFF (AOR = 4.7).

Conclusion: Engaging both fathers and mothers in care groups benefited complementary feeding of infants. Overall, this peer-led integrated nutrition education intervention through care groups improved infant complementary feeding in the West-Nile postemergency settlements in Uganda.This trial was registered at clinicaltrials.gov as NCT05584969.

Keywords: South Sudanese; Uganda; infant feeding; maternal social support; postemergency; refugee settlements.

Associated data

ClinicalTrials.gov/NCT05584969