Exploring the Program Impact Pathways of a Grandmother-inclusive Approach on Improved Infant and Young Child Feeding Outcomes at Endline: A Mediation Analysis of the Mamanieva Project in Southern Sierra Leone Público

Abstract

Sierra Leone faces significant challenges with poor nutrition. There is high prevalence of stunting (38%) and wasting (9%) and underweight (16%) among children under-5 years of age. In rural Sierra Leone, grandmothers and elder women play vital roles in maternal and child nutrition as caretakers and advisors. However, many traditional nutrition interventions do not utilize grandmothers as agents of change, but focus on health systems delivery of nutrition messages to pregnant women and mothers of young children. World Vision, in partnership with The Grandmother Project and Emory University, implemented the Mamanieva Project in Bum Chiefdom, Bonthe District, Sierra Leone.The project was a 3-year proof-of-concept study implemented from April 2013 - November 2016 aimed to empower grandmothers as key players of promoting positive change surrounding optimal maternal child and nutrition knowledge, attitudes, and practices.

This thesis project shows results of a mediation analysis done to explore the program impact pathways. Relationships between mediators and significant infant and young child feeding (IYCF) outcomes at endline were assessed. IYCF outcomes statistically significant at endline were exclusive breastfeeding during the first week of life, minimum dietary diversity, and minimum acceptable diet. Mediators assessed for this thesis were knowledge of mothers with children under-2 (MU2) and grandmothers (GM) and GM self-efficacy. A total of 291 MU2 and 148 GMs were included in the mediation analysis.

To assess the effect of mediators, associations were first examined between the intervention and key mediators, and then between significant IYCF outcomes at endline and key intervention mediators for significance at p<0.05. The results of the mediation analysis for the Mamanieva proof-of-concept study indicate that targeted intervention mediators were not key mediators in achieving the IYCF outcomes significant at endline. However, a key limitation of this analysis was small sample size. Additional mediation analyses with other project mediators should be performed, in addition to more complex pathway analyses, to identify critical components of the Mamanieva Project intervention on IYCF outcomes as well as other outcomes of interest, such as maternal nutrition indicators. Results from more complex pathway analyses will allow better allocation of resources to improve intervention effectiveness and efficiency.

Table of Contents

Introduction 1

Literature Review 4

Methods 19

Results 28

Discussion 40

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Psychology, Behavioral
Palavra-chave	Evaluation Nutrition Mediation Analysis Grandmother Approach
Committee Chair / Thesis Advisor	Girard, Amy Webb, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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