Nutrition Education Package Focusing on Infant and Young Child Feeding in Tanzania.

OBJECTIVE: To evaluate the effectiveness of a nutrition education package on feeding practices, nutrient intakes and growth of infants in rural Tanzania. DESIGN: Cluster-randomized controlled trial in 18 villages allocated to nutrition education package (n = 9) or routine health education (n = 9 villages), measured at baseline (6 months) and end of the trial (12 months). SETTING: Mpwapwa district. PARTICIPANTS: Infants aged 6-12 months and their mothers. INTERVENTION(S): Six months of nutrition education package (group education, counseling, cooking demonstrations) and regular home visits by village health workers. MAIN OUTCOME MEASURE(S): Primary outcome measure was the mean change in length-for-age z-scores. Secondary outcomes included mean changes in weight-for-length z-scores (WLZ), intakes of energy, fat, iron and zinc, the proportion of children consuming foods from ≥ 4 food groups (ie, dietary diversity) and consuming the recommended number of semisolid/soft meals and snacks per day (ie, meal frequency). ANALYSIS: Multilevel mixed-effects regression models. RESULTS: Mean change in length-for-age z-scores (ß = 0.20, P = 0.02), energy (in kcal) (ß = 43.8, P = 0.02), and fat (in grams) (ß =2.7, P = 0.03) intakes were significant in the intervention but not in the control group. There was no effect on iron and zinc intakes. More infants in the intervention than the control group consumed meals from ≥ 4 food groups (71.8% vs 45.3%, P = 0.002). The mean increase in meal frequency (ß = 0.29, P = 0.02) and dietary diversity (ß = 0.40, P = 0.01) were more significant in the intervention than control. CONCLUSIONS AND IMPLICATIONS: The nutrition education package is feasible and can be implemented with high coverage, demonstrating the potential to improve feeding practices, nutrient intake and growth in rural Tanzania.

Feeding practices and nutrient content of complementary meals in rural central Tanzania: implications for dietary adequacy and nutritional status.

BACKGROUND: Stunting and micronutrient deficiencies are significant health problems among infants and young children in rural Tanzania. Objective of the study was to assess feeding practices, nutrient content of complementary meals, and their implications for dietary adequacy and nutritional status. METHODS: A cross-sectional study was conducted in six randomly selected villages in Mpwapwa District, Tanzania during the post-harvest season. Information on feeding practices, dietary consumption and anthropometric measurements of all infants below the age of one year were collected. Forty samples of common meals were collected and analysed for proximate composition, iron, zinc and calcium. Results were expressed per 100 g dry weight. RESULTS: Energy, protein and fat content in porridge ranged from 40.67-63.92 kcal, 0.54-1.74% and 0.30-2.12%, respectively. Iron, zinc and calcium contents (mg/100 g) in porridge were 0.11-2.81, 0.10-3.23, and 25.43-125.55, respectively. Median portion sizes were small (porridge: 150-350 g; legumes and meats: 39-90 g). Very few children (6.67%) consumed animal-source foods. Low meal frequency, low nutrient content, small portion size and limited variety reduced the contribution of meals to daily nutritional needs. CONCLUSIONS: Findings of the study highlight inadequate feeding practices, low nutritional quality of meals and high prevalence of stunting. Feasible strategies are needed to address the dietary inadequacies and chronic malnutrition of rural infants.

Effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth of infants and young children in rural Tanzania: rationale, design and methods of a cluster randomised trial.

BACKGROUND: Strategies to improve infant and young child nutrition in low- and middle- income countries need to be implemented at scale. We contextualised and packaged successful strategies into a feasible intervention for implementation in rural Tanzania. Opportunities that can optimise delivery of the intervention and encourage behaviour change include mothers willingness to modifying practices; support of family members; seasonal availability and accessibility of foods; established set-up of village peers and functioning health system. The primary objective of the study is to evaluate the effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth as compared to routine health education. METHODS/DESIGN: A parallel cluster randomised controlled trial will be conducted in rural central Tanzania in 9 intervention and 9 control villages. The control group will receive routine health education offered monthly by health staff at health facilities. The intervention group will receive a nutrition education package in addition to the routine health education. The education package is comprised of four components: 1) education and counselling of mothers, 2) training community-based nutrition counsellors and monthly home visits, 3) sensitisation meetings with health staff and family members, and 4) supervision of community-based nutrition counsellors. The duration of the intervention is 9 months and infants will be recruited at 6 months of age. Primary outcome (linear growth as length-for-age Z-scores) and secondary outcomes (changes in weight-for-length Z-scores; mean intake of energy, fat, iron and zinc from complementary foods; proportion of children consuming 4 or more food groups and recommended number of semi-solid/soft meals and snacks per day; maternal level of knowledge and performance of recommended practices) will be assessed at baseline and ages 9, 12 and 15 months. Process evaluation will document reach, dose and fidelity of the intervention and context at 8 and 15 months. DISCUSSION: Results of the trial will provide evidence of the effectiveness of the nutrition education package in community settings of rural Tanzania. They will provide recommendations for strengthening the nutrition component of health education in child health services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02249754, September 25, 2014.

Constraints on good child-care practices and nutritional status in urban Dar-es-Salaam, Tanzania.

BACKGROUND: Care is increasingly being recognized as a crucial input to child health and nutrition, along with food security, availability of health services, and a healthy environment. Although significant gains have been made in the fight against malnutrition in Tanzania, the nutritional status of preschool children in urban areas is not improving. OBJECTIVE: To assess child-care practices and the nutritional status of infants and young children with the aim of improvingfeeding practices and child nutritional status. METHODS: A cross-sectional study was undertaken in urban Dar-es-Salaam, Tanzania. The study involved 100 randomly selected mothers of children 6 to 24 months old from households in Ilala Municipality, one of the three municipalities that constitute the Dar-es-Salaam City Council. Data were collected by a structured questionnaire, spot-check observations, and anthropometric measurements. RESULTS: The prevalence rates of stunting, underweight, wasting, and morbidity were 43%, 22%, 3%, and 80%, respectively. The prevalence of exclusive breastfeeding was very low (9%), and most stunted children (88%) were not exclusively breastfed for the first 6 months. The mean age at which complementary foods and fluids were introduced was 3.26 +/- 1.12 months (range, 1 to 5 months). The fluids given were mainly water and thin cereal-based porridge. More than half of the households practiced good hygiene. Most of the psychosocial practices (e.g., caregiver's attention, affection, and involvement in child feeding, hygiene, health care, and training) were performed by mothers, except for cooking and feeding the children and child training, which were done mostly by alternative caregivers. Nearly half of the mothers (44%) worked out of the home. The mean number of working hours per day was long (10.32 +/- 2.13), necessitating the use of alternative caregivers. A negative correlation was found between height-for-age z-scores and the number of hours mothers worked outside the home. CONCLUSIONS: The prevalence rates of chronic malnutrition and morbidity are high, and child-feeding practices are inadequate in this urban population. Maternal employment and educational characteristics constrain good child-care practices, and alternative caregivers are taking a more important role in child care as mothers join the work force. We recommend that formative research be conducted to study the actual practices of caregivers in order to form the basis for a child-care education program. There is also a need to strengthen national health system support for improved child feeding.