Evaluation of Community-led Complementary Feeding and Learning Sessions

Thesis (Master's)--University of Washington, 2016-08

Background Undernutrition during the 1,000 most critical days – pregnancy through the first 24 months of life – is a particular risk factor for morbidity and mortality among infants and young children. Inadequate knowledge about complementary foods and feeding practices is often the cause and can be a greater determinant of undernutrition than lack of food. To help address undernutrition between 6 and 23 months of age, Catholic Relief Services (CRS) developed Community-led Complementary Feeding and Learning Sessions (CCFLS), a preventive model building on the Positive Deviance (PD)/Hearth approach. PD/Hearth is a home-based and community-based recuperative nutrition approach for children at risk for protein-energy malnutrition in developing countries. CCFLS aims to enable households to improve their nutrition through high-nutrient, low-cost and available foods. CRS Zambia leads the five-year Mawa project, which aims to improve food and economic security for households in target communities Chipata and Lundazi districts in Zambia’s Eastern Province. CCFLS is one component of Mawa’s integrated approach and targets children at risk for underweight aged 6 to 23 months with a weight for age (WAZ) Z score below 0 standard deviation (SD) and above -2 SD. Research Question What is the mean weight gain of Zambian children aged 6 to 23 months with a WAZ less than 0 SD and greater than -2 SD who participate in CCFLS compared to the 400 gram weight gain expected under the PD/Hearth model? Methods We analyzed child weight and length data collected by the CRS Mawa project during CCFLS sessions and six-month follow up visits. All variables were analyzed using descriptive and multivariable analyses using IBM SPSS Statistics Version 19. WHO Child Growth Standards SPSS Syntax File was used to calculate Z scores. All variables were disaggregated by sex and age (6-11 months and 12-23 months). Results Out of 144 children in study, 91 were girls (63%), 56 were 6 to 11 months of age (39%) and 88 were 12 to 23 months (61%). By day 12 of CCFLS, the mean weight gain was 250 grams (290 for boys and 230 for girls). Forty-six children (32%) had gained at least 400 grams (the target weight gain), with more boys reaching 400 grams (42%) than girls (26%). The mean weight gain from day 1 of CCFLS to the six-month follow up visit was 1,360 grams, with boys gaining slightly less than girls (1,260 to 1,420 grams respectively). The mean six-month weight gain overall was 1% more than what would be expected per the World Health Organization (WHO) child growth standards (1,350 grams); while the mean weight gain for boys was 7% less than the WHO expected weight gain, the mean weight gain for girls was 5% greater than the WHO expected weight gain. The mean six-month length gain was 4.7 cm, with 4.3 cm for boys and 5 cm for girls. The mean six-month length gain was 27% lower than expected per the WHO child growth standards, with the mean length gain for boys 33% less than WHO standards and the mean six-month length gain for girls 25% less than the WHO standards. Conclusion Children participating in CCFLS generally demonstrated robust weight gain over the six-month follow up period, i.e., mean ponderal growth relatively close to or exceeding the expected according to WHO growth standards. Height gain was not as robust. This analysis calls into question whether the target weight gain of 400 grams over the 12-day CCFLS sessions, a target weight gain which was carried over from PD/Hearth, a recuperative program, is the most appropriate for CCFLS as a preventive intervention. Four hundred grams is much higher than what would be expected for children following a growth trajectory based on WHO growth standards over a 12-day period. Despite study limitations related to the lack of a comparison group, insufficient data quality, the small sample size, and unclear attribution of six-month follow up data due to other Mawa and community interventions, these results indicate that CCFLS is a promising intervention. Enrollment in the program is ongoing; more in-depth analysis of Mawa CCFLS data is required to better understand the impact of the program.