Effectiveness of an Educational Intervention on Complementary Feeding Practices and Growth in Rural China

Published in the journal Public Health Nutrition (13(4):556-65), this report describes a cluster randomised controlled study whose purpose was to assess the effects of an educational intervention delivered through local healthcare providers on caregiver feeding practices and infant growth. In short, the study found that this intervention indeed improved caregiver behaviours around complementary feeding, and - by extension - infant growth.

The context for the intervention is as follows. Data from a Nutrition Surveillance Program indicated that, in 2000, 20% of rural preschool children in China were stunted and 14% were underweight - rates much higher than those of their urban counterparts. Research has shown that the poor nutritional status of rural Chinese children may be attributable in part to poor complementary feeding practices. A large barrier to optimal complementary feeding is the belief that it is inappropriate to feed nutrient-rich foods such as meat, eggs, and vegetables to infants because these foods are considered too difficult for the infant to digest.

The educational intervention included 4 main components: 1) group training sessions on food selection, preparation and hygiene, childhood nutrition and growth, and responsive feeding; 2) demonstration of the preparation of enhanced complementary food recipes, which were formulated using locally available, affordable, acceptable, and nutrient-dense foods; 3) booklets that contained infant feeding guidance and methods of preparing the recommended recipes; and 4) home visits every 3 months to identify possible feeding problems and provide individual counselling. Four townships were randomly assigned to each group, resulting in 294 infants in the education group and 305 infants in the control group. Infants were enrolled in the study at 2-4 months of age and followed up to collect data at 6, 9, and 12 months of age.

Compared to infants in the control group, a greater proportion of infants in the education group were reported to have consumed meats, eggs, yellow or orange foods, dark green leafy vegetables, fruits, cooking oil, and beans at all time points. The respective proportions at 12 months were: 97% vs. 58% for meats or organ meats; 92% vs. 67% for beans; and 97% vs. 77% for yellow or orange foods. Infants in the education group had higher meal frequency than their control counterparts at 6 months (1.6 vs. 1.1), 9 months (3.8 vs. 2.5), and 12 months (4.2 vs. 2.9).

Compared to mothers in the control group, more mothers in the education group reported that they: washed their own hands and their children's hands before meals; washed hands using soap and clean water; cooked for the child; and encouraged their infant to eat when he/she refused food.

Mean weight and length at 12 months of age were similar between groups, but infants in the education group had more rapid gain in weight (3.3 vs. 3.0 kg) and length (14.2 vs. 13.5 cm) over the study period compared to control infants.