Frontline Worker and Household Knowledge of Infant and Young Child Feeding in Bihar, India Open Access

Colbourne, Katrina Louise (2015)

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Introduction: Stunting, severe wasting, and intrauterine growth restriction cause an estimated 2.2 million deaths and 21% of disability-adjusted life-years for children under the age of five. Complementary feeding after six months of age is necessary as breast milk alone ceases to provide all the required nutrients that a child needs. Although complementary feeding amongst children between the ages of 6 to 24 months is critical to improve child nutrition, progress has been slow, as it has emerged as one of the most challenging and complicated issues. CARE India's Integrated Family Health Initiative (IFHI) focuses on training frontline workers (FLW) to deliver counseling messages to households (HH).

Objectives: The objectives were to 1) describe FLW knowledge and use of job aids; 2) describe HH knowledge and practices related to IYCF; and 3) to identify program gaps and recommendations for program improvements.

Methods: 28 in-depth interviews of FLWs and HHs in two high performing blocks and two low performing blocks were conducted to examine knowledge and practice of complementary feeding content and job aids. MAXQDA 11 was utilized to analyze the data through coding, segmenting, and thematic analysis.

Results: There was a significant and alarming gap between FLW knowledge of complementary feeding guidelines and job aids and HH knowledge and practice. FLWs had moderate to high levels of knowledge, except for a few inconsistencies associated with quantity, consistency, responsive feeding, and the use of job aids. HHs had low to moderate levels of knowledge for the complementary feeding content. HHs who received home visits were more knowledgeable than those who did not; however, there was a low prevalence of HHs reporting the receipt of home visits.

Discussion: Counseling messages about nutrition during home visits can increase HH knowledge, but the low prevalence of completed home visits is the main identified issue. Recommendations include motivating FLWs through regular updates of statistics and case studies, utilizing a team-based approach with a reward system, and using positive deviance amongst FLWs and HHs. Moreover, further training is recommended for the concepts of quantity, consistency, responsive feeding, and the use of job aids.

Table of Contents



Nutrition in India...3

Nutrition in Bihar...3

Frontline Worker's Role in Nutrition...4

CARE India Integrated Family Health Initiative...5


Study Site...7

Study Population and Sample Size...8

Design of Research Tools...9

Identification and Recruitment of Participants...9

IRB Approval and Informed Consent...10

Data Analysis...10


Objective One: Describe FLW Knowledge and Use of Job Aids...12

Initiation of Complementary Feeding...13

Quantity and Frequency of Complementary Feeding...14

Consistency of Complementary Feeding...15

Hand Hygiene...16

Diversity of Complementary Feeding...17

Responsive Feeding...17


Mobile Kunji...19

Home Visit Planner...19

Objective Two: Describe HH Knowledge and Practices Related to IYCF...20

Initiation of Complementary Feeding...20

Quantity and Frequency of Complementary Feeding...21

Consistency of Complementary Feeding...22

Hand Hygiene...22

Diversity of Complementary Feeding...23

Responsive Feeding...23

Katori and Mobile Kunji...23

Other Findings...24


Program Gaps...26

Gap Between FLW and HH Knowledge of IYCF Content...26

Gap Between FLW Job Aid Use/Knowledge and HH Knowledge...27

Low Prevalence of Home Visits...27

Current Research...28


Motivate FLWs...28

Positive Deviance...29

Further Training...30

Other Recommendations...31

Limitations and Strengths...31

Additional Questions...32



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