Impact of Evidence-Based Behavior Change Communication on Infant and Young Child Feeding (IYCF) Practices in Tribal Gujarat, India

Background: Poor IYCF-practices increase the risk of malnutrition and poor developmental outcomes. Low literacy, poor socio-economic conditions, and missed opportunities for counselling in hard-to-reach, interior tribal villages may adversely influence IYCF-practices.

Objective: To assess impact of behaviour change communication(BCC) on IYCF-practices in 6-12M infants in tribal Gujarat, India

Design/Methods: Two blocks were randomly assigned to control(CC;N=541) and intervention(IC;N=474) clusters. Pregnant women in their third trimester(Cohort-1;N=610) and mothers of 0-3M infants(Cohort-2;N=405) were recruited in both clusters at baseline(N=1015) during Apr-Jul’16. Enrollee in the intervention group received interpersonal BCC for age-appropriate IYCF-practices (including discouragement of traditional, harmful feeding practices) at baseline, mid-line(Aug-Dec’16), and recipe demonstration and group counselling(Dec’16-Jan’17). End-line assessment(Jan-Mar’17) assessed the impact of BCC on maternal awareness and IYCF-practices.

Results: At baseline, maternal profile and awareness about IYCF-practices were similar in IC and CC. Lost-to-follow-up much higher than anticipated at end-line in CC and IC(228;48% vs. 299;55%) mainly attributed to out-migration. Being male(129;48.86% vs. 89;37.71%) and first child(70;52.24% vs. 148;40.44%) were significantly associated (p<0.02) with minimum meal frequency(MMF) for 6-8M and 9-12M infants. Minimum dietary diversity(MDD), i.e. infants receiving foods from four or more food groups, were similar(18;7.29% vs. 16;6.32%) in IC and CC. Among those who failed to achieve MDD, 35;14.17% and 29;11.46% in IC and CC received foods from three food groups, whereas 90;36.44% and 86;33.99% did not receive any complementary feeding in past 24 hours.

Conclusion(s): MDD practice improved during end-line compared to mid-line during which none of the infants in cohort-2 in IC and CC received meals from 4 or more food groups. However, both MMF and MMD remained sub-optimal over the course of the intervention assessment. While socio-economic status, food insecurity and migration could influence CF practices, further research is required to identify context-specific barriers and locally adaptable solutions to curb malnutrition in tribal population.