United States Agency for International Development (USAID) Infant and Young Child Nutrition Project., Washington, DC, USA. Now with USAID Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project, Arlington, VA, USA.
USAID Infant and Young Child Nutrition Project, Washington, DC, USA. Now with Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA.
Glob Health Sci Pract. 2016 Mar 25;4(1):55-72. doi: 10.9745/GHSP-D-15-00197. Print 2016 Mar.
We designed and tested an intervention that used dialogue-based groups to engage infants' fathers and grandmothers to support optimal infant feeding practices. The study's aim was to test the effectiveness of increased social support by key household influencers on improving mothers' complementary feeding practices.
Using a quasi-experimental design, we enrolled mothers, fathers, and grandmothers from households with infants 6-9 months old in 3 rural communities (1 intervention arm with fathers, 1 intervention arm with grandmothers, and 1 comparison arm) in western Kenya. We engaged 79 grandmothers and 85 fathers in separate dialogue groups for 6 months from January to July 2012. They received information on health and nutrition and were encouraged to provide social support to mothers (defined as specific physical actions in the past 2 weeks or material support actions in the past month). We conducted a baseline household survey in December 2011 in the 3 communities and returned to the same households in July 2012 for an endline survey. We used a difference-in-difference (DiD) approach and logistic regression to evaluate the intervention.
We surveyed 554 people at baseline (258 mothers, 165 grandmothers, and 131 fathers) and 509 participants at endline. The percentage of mothers who reported receiving 5 or more social support actions (of a possible 12) ranged from 58% to 66% at baseline in the 3 groups. By endline, the percentage had increased by 25.8 percentage points (P=.002) and 32.7 percentage points (P=.001) more in the father and the grandmother intervention group, respectively, than in the comparison group. As the number of social support actions increased in the 3 groups, the likelihood of a mother reporting that she had fed her infant the minimum number of meals in the past 24 hours also increased between baseline and endline (odds ratio [OR], 1.14; confidence interval [CI], 1.00 to 1.30; P=.047). When taking into account the interaction effects of intervention area and increasing social support over time, we found a significant association in the grandmother intervention area on dietary diversity (OR, 1.19; CI, 1.01 to 1.40; P=.04). No significant effects were found on minimum acceptable diet.
Engaging fathers and grandmothers of infants to improve their knowledge of optimal infant feeding practices and to encourage provision of social support to mothers could help improve some feeding practices. Future studies should engage all key household influencers in a family-centered approach to practice and support infant feeding recommendations.
我们设计并测试了一项干预措施，该措施利用基于对话的小组来促使婴儿的父亲和祖母参与，以支持最佳的婴儿喂养实践。该研究的目的是测试通过主要家庭影响者增加社会支持对改善母亲补充喂养实践的效果。
采用准实验设计，我们在肯尼亚西部的 3 个农村社区（1 个干预组有父亲，1 个干预组有祖母，1 个对照组）招募了 6-9 个月大婴儿的母亲、父亲和祖母。从 2012 年 1 月到 7 月，我们对 79 位祖母和 85 位父亲进行了为期 6 个月的单独对话小组活动。他们获得了有关健康和营养的信息，并被鼓励为母亲提供社会支持（定义为过去 2 周内的具体身体行为或过去 1 个月内的物质支持行为）。我们于 2011 年 12 月在 3 个社区进行了基线家庭调查，并于 2012 年 7 月回到同一家庭进行了期末调查。我们使用差异-差异（DiD）方法和逻辑回归来评估干预措施。
我们在基线时调查了 554 人（258 位母亲、165 位祖母和 131 位父亲），在期末时调查了 509 位参与者。在 3 个组中，报告收到 5 次或更多次社会支持行为（总共 12 次）的母亲的百分比在基线时为 58%至 66%。到期末时，父亲和祖母干预组分别增加了 25.8 个百分点（P=.002）和 32.7 个百分点（P=.001），而对照组则增加了 15.3 个百分点。随着 3 组中社会支持行为的增加，报告在过去 24 小时内给婴儿喂食最少餐数的母亲的可能性也在基线和期末之间增加（优势比[OR]，1.14；置信区间[CI]，1.00 至 1.30；P=.047）。当考虑到干预区域和随时间增加的社会支持的交互效应时，我们发现祖母干预区域在饮食多样性方面存在显著关联（OR，1.19；CI，1.01 至 1.40；P=.04）。没有发现对最低可接受饮食有任何显著影响。
让婴儿的父亲和祖母参与进来，以提高他们对最佳婴儿喂养实践的认识，并鼓励他们为母亲提供社会支持，可能有助于改善一些喂养实践。未来的研究应采用以家庭为中心的方法，让所有主要家庭影响者参与到实践和支持婴儿喂养建议中来。
