The Addition of a Feeding Toolkit to a Nutrition Sensitive Agriculture Intervention Significantly Enhanced Complementary Feeding Practices in SNNPR, Ethiopia: Results from a Longitudinal Cluster Randomized Controlled Trial Open Access

Pyo, Euisun (Spring 2019)

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Background Poor complementary feeding (CF) is a major risk factor for the global burden of childhood undernutrition. Quality Diets for Better Health (QDBH) is an integrative agricultural project that aims to improve vitamin A intake and nutrition quality of young children in Ethiopia through promotion of vitamin A rich and climate-sensitive orange flesh sweet potatoes and community-based nutrition education.

Objective This study aims to evaluate the effects of adding child feeding tools to the QDBH package on CF practices and potential effect modification by household food security.

Methods Twenty kebeles in two districts of SNNPR were randomly allocated to one of three intervention groups: full intervention, received feeding toolkit with OFSP promotion and nutrition education; partial intervention, received OFSP promotion and nutrition education; control, scheduled to receive partial intervention at a later date. Effects of the intervention arms were assessed longitudinally among 605 households from participating kebeles. Intent-to-treat analysis applied adjusted logistic regression to examine CF outcomes by intervention group. For as-treated analyses, we created exposure dose scores based on receipt of specific program components and analyzed associations with CF outcomes using logistic regression. Food security status was assessed using the food insecurity experiences scale, and interactions between intervention and food security for CF outcomes was assessed using the chunk test.

Results Controlling for covariates, the odds of meeting minimum dietary diversity (MDD) and minimum acceptable diet (MAD) for a child 6-13 months of age was each significantly higher in the full compared to the control (aOR MDD: 2.40, [2.01, 2.87]; aOR MAD: 2.63, [2.23, 3.09]). The intervention was not significantly associated with minimum meal frequency (MMF). For every additional intervention component received, the odds of achieving MDD and MAD increased by 28% and 27%, respectively. For child’s consumption of vitamin A-rich fruits and vegetables, the odds increased in a dose-response manner to both exposures. There was no significant effect modification by food security status.

Conclusion Receipt of the full intervention and each unit increase in program components were each associated with improvements in achieving adequate dietary diversity and overall diet quality in children aged 6 to 13 months.

Table of Contents


1.1 Childhood Undernutrition 1

1.2 Vitamin A Deficiency in Children 2

1.3 Complementary Feeding 3

1.4 Improving Child Nutrition with Complementary Feeding 5

1.5 Child Feeding Tools 6

1.6 Agricultural Intervention 8

1.7 Challenges in Ethiopia: Undernutrition and Complementary Feeding 9

1.8 The Quality Diets for Better Health Project 11


2.1 Title 14

2.2 Contribution of the Student 14

2.3 Abstract 14

2.4 Introduction 16

2.5 Methods 18

2.6 Results 26

2.7 Discussion 28

2.8 References 34

2.9 Tables and Figures 41


Appendix: Supplementary Figures and Tables 47

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