Does nutrition education improve complementary feeding practices and mothers nutrition knowledge? A case study of Western Kenya presented by Jacqueline Kipkorir PhD Student,, Kenyatta University Find out more about this research: http://www.bioversityinternational.org/news/detail/improving-nutrition-through-local-agricultural-biodiversity-in-kenya/

1. Does nutrition education improve complementary
feeding practices and mothers nutrition
knowledge? A case study of Western Kenya
Jacqueline Kipkorir PhD Student , Kenyatta University
28th August 2014

2. Background I
• 35% of children in Kenya are stunted (KNBS & ICF Macro,
2010)
• Complementary foods in Kenya, consist of mostly grain
and starchy staples and introduced early (KNBS & ICF
Macro, 2010)
• Inadequate knowledge on appropriate foods and poor
feeding practices is a greater determinant of malnutrition
that actual lack of food among young children (Krebs et al,
2011)
• 600,000 child deaths can be prevented through adequate
complementary feeding practices (Krebs et al., 2011)

3. Background II
• Adequate complementary feeding practices can
help prevent stunting and iron deficiency (Smith &
Haddad, 1999; Hotz & Gibson, 2005)
• Maternal education has a positive effect on
complementary feeding practices and improved child
health (Smith & Haddad, 1999;Shi & Zhang, 2010)
• Nutrition education improved breastfeeding
practices and reduced growth faltering rates (Dewey
& Adu-Afarwuah, 2008)

4. Overall Objective
To determine effect of nutrition education
complementary feeding practices and
mothers nutrition knowledge

5. Study Hypotheses
H01: There is no significant difference between the
control and intervention group with regard to
complementary feeding practices.
H02: There is no significant difference between the
control and intervention group with regard to
maternal nutrition knowledge

6. Study Setting
8
Mumias
LM1
1800-2000 mm
Vihiga
UM1
>2000 mm

7. Study Flow
Baseline survey in households with children 6-23 months and their caregivers
Middle survey in same households with children 6-23 months and their caregivers
to capture seasonal differences, Nov 2012 (n=218)
Intervention Group (10 villages) Control Group (10 villages)
9
Jul/Aug 2012 (n=300)
Restricted cluster randomization (using baseline results)
District, AEZs, wealth index, stunting, CDDS, education level of caregivers
Nutrition education sessions on
complementary feeding
Feb-Jun 2013
Endline survey in households children aged 6-23 months and their caregivers
Jul/Aug 2013 ; Intervention group (n=101),Control group (n=100)

8. Study Population
• Baseline survey
• Households with caregivers and children 6-23 months
• Two stage cluster sampling
 15 villages randomly from each district proportional to population size
 10 households randomly selected per village
• Intervention
 10-15 caregivers with children 6-17 months in each intervention village
• Endline survey
• Intervention group: All caregivers who participated in the NE
• Control group: 10 households per village randomly selected
 201 caregivers interviewed: Control (n=100), Intervention (n=101)

9. Nutrition education sesssions
Sessions Time Topics Materials
1 February • The importance of complementary feeding
Main activity: participatory group discussions
IYCF materials
2 February-
March
• Dietary diversity during complementary
feeding
• Cooking demonstration
Main activities: participatory group discussions and
cooking demonstration
Food circle, Seasonal
food availability
calendars,
Locally available foods
General Elections in March 2013 and Follow-up visits in April 2013
3 May • Making nutritious and diverse meals for
children aged 6-23 months
• Cooking demonstration
Main activities: participatory group discussions and
cooking demonstration
IYCF materials, Food
circle, Seasonal food
availability calendars,
Locally available foods
4 June • How to obtain and prepare adequate and
nutritious meals for children 6-23 months
Main activities: group discussions and presentations
Posters, Brochures:
Food circle, Nutritious
snacks etc.
The themes and topics for the nutrition education sessions were selected based on the findings from the
baseline survey with reference to materials from FAO 2004 and UNICEF 2012

10. Data Collection
• Structured household questionnaires
– Level of education
– Occupation
– Complementary feeding practices
– Mothers knowledge on nutrition
– etc.
• 24 hour recall and 7-day food frequency
• Anthropometric measurements of mothers and children
• Focus group discussions on complementary feeding
practices

11. © (FAO, 2011)
Data Analysis I
• Data was analysed using SPSS 22.0
• Dietary diversity scores (DDS): sum of food groups
consumed during one day
– Child Dietary Diversity Score (CDDS): Maximum 7 food
groups (WHO 2010)
– Women Dietary Diversity Score (FAO 2011)
– Household Dietary Diversity Score (FAO 2011)

12. Data Analysis II
• Knowledge Assessment is based on 10 questions that assessed
tested nutrition knowledge. Each question was given a maximum
score of 6. Total Score was 60. The score was assigned as follows
Attribute Score
1 No Knowledge 0
2 Low Knowledge 1-12
3 Average Knowledge 13-24
4 Adequate Knowledge 25-36
5 Good knowledge 37-48
6 Excellent Knowledge 49-60
• Mann-Whitney test and Chi Square statistics to test for significance

13. Infant and Young Child Feeding(IYCF) Indicators
– Continued breastfeeding: Children 12-15 months of age
who received breast milk in the previous day
– Minimum Dietary Diversity (MDD): > 4 food groups per
day
– Minimum Meal Frequency (MMF): > 3 meals per day
– Minimum Acceptable Diet (MAD): Children who received
> 4 food groups and > 3 meals a day
– Consumption of iron fortified and iron rich foods:
number of children who received iron fortified foods divided
by the number of children 6-23 months

14. Results

15. Selected characteristics of study households (n=201)
Characteristic Intervention Control
Mean SD Mean SD
Age of mother (years) 30 7.2 30 9.4
Age of child (months) 16 5.8 16 5.3
Knowledge Score (mean) (0-60) 21 10.4 12.4 8.6
Household size 6 2.2 5.7 2
Land acreage (acres) 0.9 1.0 0.7 0.8
CDDS (0-7) 4.11 1.0 3.2 1.1
HDDS (0-12) 7.72 1.2 7.13 1.3
Characteristic (%) Intervention Control
Marital Status
Married 92 94
Widowed/Single 8 6

16. Level of education (Mother)
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Some primary Completed
primary
(standard 8)
Some
secondary
Completed
Secondary (
Form 4
Intervention
Control

17. Complementary Feeding Practices I
Characteristic Intervention (n=101) Control (n=100)
Mean SD Mean SD
Exclusive breastfeeding (mean
age)
4.5 2.3 3.2 2.2
Start of Complementary feeding 4.7 1.9 3.4 2.3
Number of times semisolids and
4.7 1.2 4.5 1.2
solids consumed previous day
Characteristic (%) Intervention Control
Pre-lacteal feeds 10.9 15
Fed liquids, solid or semi solid
100 100
foods
Preparation of extra meal for
child
79.8 74
Child still being breastfed 75.2 73

18. Consumption of various food groups (Children)
Grains,roots and tubers
Other fruits and vegetables
Dairy products
Fleshy and organ meat
Vitamin A rich fruits and…
0 20 40 60 80 100
Legumes and nuts
Eggs
Control Intervention

19. Complementary feeding practices I
Variable
n
Intervention
(%) n
Control
(%) P
Minimum
Dietary Diversity
74 73 42 42 <0.001
Minimum Meal
Frequency
99 98 94 94 0.145
Consumption of
iron fortified and
iron rich foods
61 60 49 49 <0.001
* Chi Square test

20. Knowledge Assessment
Variable n Intervention n Control P
Knowledge Score
101 20.7(10.4) 10
12.4
(mean, SD)
0
(8.6)
<0.001
1 No Knowledge (%) 3 3 12 12
2 Low knowledge (%) 21 20.8 37 37
3 Average knowledge
(%)
40 39.6 43 43
4 Adequate knowledge
(%)
32 31.7 7 7
5 Good knowledge (%) 5 5 1 1
6 Excellent Knowledge
(%)
0 0 0 0
* Mann-Whitney

21. Conclusion &
Recommendations

22. Conclusion
• Nutrition education was beneficial in improving MDD
and Consumption of iron rich foods. Reject
hypothesis 1
• Nutrition Education was beneficial in improving
maternal nutritional knowledge. Reject hypothesis 2

23. Recommendation
• More focus on nutrition education as an intervention
together with other IYCF strategies to improve infant
and young child feeding practices
• Development of a curriculum for nutrition education
specifically targeted at complementary feeding to go
hand in hand with other available IYCF materials
• Determination of nutrient quality of locally available
foods to be used in complementary feeding

24. Next Steps
• Data analysis to continue using baseline, middle and endline
– Differences in difference test to be applied to baseline and end line
data to allow for comparison.
– Comparison of baseline and end line; Intervention and Control with
regard to
• Complementary feeding practices (Frequency, Amount and
Dietary diversity)
• Maternal nutritional knowledge
• Nutrient intake
• Nutritional status of children
• Determine if nutritional knowledge of the mothers has an effect
on practice
– Perform further statistical analysis

25. Acknowledgement
• Federal Ministry of Economic Cooperation and
Development, Germany and the CGIAR Research
Programme on Agriculture for Nutrition and Health(A4NH)
for funding
• Supervisors
– Prof Judith Kimiywe
– Dr. Gudrun Keding
• Bioversity International
• Study participants
• INULA colleagues

26. Thank you
www.bioversityinternational.org