Morbidity Evaluation of an Innovative Feeding Toolkit to Improve Complementary Feeding in Malawi Shows No Significant Increase in Diarrhea Open Access

Abstract

Objective. The aim of the present study was to test the association between an innovative feeding toolkit and the impact of the intervention on morbidity. We additionally assessed predictors of childhood diarrhea.

Design. A cluster randomized controlled study, where clusters were randomized to one of two groups. Households in the intervention were eligible to receive a toolkit consisting of a bowl with demarcations on age-appropriate meal volumes; a slotted spoon designed to promote optimal food consistency; and nutrition education. Caregivers in the control received nutrition education only.

Setting. Mduwa, Mkanda, and Zulu Traditional Authorities in Mchinji District, Malawi.

Subjects. 1,331 caregivers of children 6-17 months at baseline were enrolled in June/July 2015. 962 of the same households and 48 additional households were followed up with in June/July 2016. Participants were analyzed as intent-to-treat, per protocol, and per uptake.

Results. In per protocol logistic regression analyses with diarrhea as the primary outcome, there appeared to be no significant effect modification between the toolkit and a-priori effect modifiers. We observed no statistically significant association between the intervention and diarrheal morbidity (OR: 0.92; 95% CI: 0.60, 1.40). Food security and age category were significant predictors of childhood diarrhea (aOR: 0.62; 95% CI: 0.40, 0.95; aOR: 0.63; 95% CI: 0.49, 0.80, respectively).

Conclusions. We observed no beneficial effect or unintended consequences associated with the feeding toolkit and morbidity. While younger age is an expected risk factor for diarrhea, nutrition-sensitive interventions should be considered to address food security and its impact on diarrhea.

Table of Contents

Chapter I: Background……………….………….………….…………..

1

Chapter II: Manuscript……….………………….……….….………….

10

Abstract……….………….………….………….………….…………………......

10

Introduction…….…………….………….………….………….……….........

12

Methods….……….………….………….………….………….…………….......

16

Results………….…………….………….………….………….……………….....

24

Discussion…………….……………….….………….………….…………….....

27

References……....…………….…………..………….………….……….......

32

Tables and Figures………….……….………….………….……….….......

37

-Figure 1………….………….……….………….……….………….……........

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-Figure 2………….……….………….………….……….………….……........

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-Table 1………….……….………….………….……….………….…….........

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-Table 2………….………….……….………….……….…………………........

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-Table 3………….………….……….………….……….…………………........

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-Figure 3………….………….………………….………….……….….…........

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Appendices.……….………………………….………….……….……….….....

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Chapter III: Summary, Public Health Implications, Possible Future Directions.............................................

59

References………………………………………………………………………...

64

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Infant and Young Child Feeding Nutrition intervention Feeding bowl Nutrition and infection
Committee Chair / Thesis Advisor	Girard, Amy Webb, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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