Care groups in an integrated nutrition education intervention improved infant growth among South Sudanese refugees in Uganda's West Nile post-emergency settlements: 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:10.1371/journal.pone.0300334

Care groups in an integrated nutrition education intervention improved infant growth among South Sudanese refugees in Uganda's West Nile post-emergency settlements: A cluster randomized trial

PLoS One. 2024 Mar 15;19(3):e0300334. doi: 10.1371/journal.pone.0300334. eCollection 2024.

Authors

Joel J Komakech¹, Sam R Emerson², Ki L Cole³, Christine N Walters², Hasina Rakotomanana², Margaret K Kabahenda⁴, Deana A Hildebrand², Barbara J Stoecker²

Affiliations

¹ Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, Mississippi, United States of America.
² Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, United States of America.
³ Research, Evaluation, Measurement, and Statistics Department, Oklahoma State University, Stillwater, OK, United States of America.
⁴ Department of Food Technology and Nutrition, Makerere University, Kampala, Uganda.

Abstract

Objective: This study examined the effects of a peer-led integrated nutrition education intervention with maternal social support using Care Groups on infant growth among South Sudanese refugees in Uganda.

Methods: A community-based cluster-randomized trial (RCT) was conducted among 390 pregnant women (third trimester). Two intervention study arms were Mothers-only(n = 131) and Parents-combined (n = 142) with a Control (n = 117). WHO infant growth standards defined length-for-age z-scores (LAZ) for stunting, weight-for-age z-scores (WAZ) for underweight and weight-for-length z-scores (WLZ) for wasting. The Medical Outcomes Study (MOS) social support index was a proxy measure for social support. A split-plot ANOVA tested the interaction effects of social support, intervention, and time on infant growth after adjusting for covariates. Further, pairwise comparisons explained mean differences in infant growth among the study arms.

Results: The mean infant birth weight was 3.1 ± 0.5 kg. Over the study period, infant stunting was most prevalent in the Control (≥ 14%) compared to Mothers-only (< 9.5%) and Parents-combined (< 7.4%) arms. There were significant interaction effects of the Care Group intervention and social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). Simple main effects by the end of the study showed that the intervention improved infant mean LAZ (Mothers-only vs. Control (mean difference, MD) = 2.05, p < 0.001; Parents-combined vs. Control, MD = 2.00, p < 0.001) and WAZ (Mothers-only vs. Control, MD = 1.27, p < 0.001; Parents-combined vs. Control, MD = 1.28, p < 0.001).

Conclusion: Maternal social support with an integrated nutrition education intervention significantly improved infant stunting and underweight. Nutrition-sensitive approaches focused on reducing child undernutrition among post-emergency refugees may benefit from using Care Groups in programs.

Trial registration: Clinicaltrials.gov, NCT05584969.

Copyright: © 2024 Komakech et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Randomized Controlled Trial

MeSH terms

Child
Female
Growth Disorders / epidemiology
Growth Disorders / prevention & control
Humans
Infant
Mothers / education
Pregnancy
Refugees*
Thinness*
Uganda / epidemiology

Associated data

ClinicalTrials.gov/NCT05584969

Grants and funding

JJK Received the research grant Grant Number: 2336 Name of funder: This research was funded by a grant from the Nestlé Foundation for the Study of Problems of Nutrition in the World, Switzerland. URL:https://www.nestlefoundation.org/ Funding statement: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.