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

Infant and young child feeding practices on Unguja Island in Zanzibar, Tanzania: a ProPAN based analysis

Background: Undernutrition in children has remained a challenge despite the success achieved in reduction of other childhood diseases in Zanzibar. Most empirical studies on infants and young child feeding (IYCF) have examined nutritional value of foods fed to the children in terms of energy and micronutrient content. Little is known on the role of culture, traditions and social norms in influencing IYCF practices. This study aimed at assessing the existing IYCF practices and socio-cultural factors influencing these practises using ProPAN tool to get an in-depth understanding of the mothers’ practices with respect to exclusive breastfeeding and infant and young child feeding.Methods: A cross sectional study involving mothers/caregivers was conducted using semi-structured interviews and opportunistic observations on Unguja Island, Zanzibar. A random selection of 36 Shehias and 213 households with children 0 – 23 months old was done proportional-to-size of Shehias and children. Quantitative and qualitative data were collected using the ProPAN tool and embedded software for analyses.Results: A total of 213 of mothers/caregivers were involved in the study. Almost all new-borns were fed colostrum (96%). Proportion of mothers who   initiated breastfeeding within one hour after giving birth was 63%. About 24% of the women practiced exclusive breastfeeding and 21% of the children were given pre-lacteal feeds 2-3 days after birth. The mean age of introduction of complementary foods was four months. Responsive feeding was not practiced by some mothers as 31% of the children 12-23 months of age were left to eat alone without any support from caregivers. The common reasons for non-adherence to the recommended feeding practices were related to income and socio-cultural norms which are strong in the community and supported by other family members.Conclusion: Infant and young child feeding in Unguja was suboptimal. Inadequate care practices, use of pre-lacteals, early introduction of complementary foods, low rate of exclusive breastfeeding and low meal frequency were among the common practices. The main causes of the observed feeding practice were related to socio-cultural norms and beliefs. There is a need to strengthen IYCF education into the antenatal clinic regime

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

Research Article published by Kulwa et al. BMC PediatricsBackground: 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

Additional file 2: of Feeding practices and nutrient content of complementary meals in rural central Tanzania: implications for dietary adequacy and nutritional status

Description of ingredients and methods of preparing different types of porridge. (DOC 49 kb

Additional file 3: of Feeding practices and nutrient content of complementary meals in rural central Tanzania: implications for dietary adequacy and nutritional status

Description and methods for preparation of staple and accompanied relish. (DOC 45 kb

Adequacy of macro and micronutrients in infants and young children\u2019s diets in Zanzibar, Tanzania

Background: A study was conducted in Zanzibar using ProPAN software to assess nutrient adequacy of foods given to infants and children aged 6-23 months old in Zanzibar. Methodology: The 24-hr dietary recall method embedded in ProPAN software was used to determine the adequacy of energy, protein, iron, calcium, zinc and vitamin A in foods consumed by children. Sample of 200 mothers/caretakers with children aged 6-23 months were interviewed. Results: Most frequent foods given to infants and children were tea, bread, white rice and fish. Key nutrients such as iron, zinc and vitamin A were below the recommended levels except for vitamin C from the diets consumed by children aged 11-23 months. Energy and protein were considered to be adequate as more than 90% of the children received enough of these nutrients. Mean age of introduction of complementary foods was four months. Conclusion: Children diets were limited in fruits and vegetables that caused micronutrients of nutritional importance such as iron, zinc and vitamin A to be supplied below recommended level. Equally, fat intake was below recommended level. Nutrition education on appropriate complementary foods should be given to caregivers. Promotion of consumption of diversified diets and locally available nutrient dense foods should be emphasized so as to achieve adequate intake of nutrients to infants and young children