Peer support groups improve infant growth and complementary feeding practices among refugees in post-emergency settlements in the west-Nile region in Uganda
Abstract
Inadequate feeding practices and child undernutrition remain a primary health concern of refugees in post-emergencies. This study examined the effectiveness of a peer-led integrated nutrition education intervention using the Care Groups on infant nutrition and growth among refugees in Uganda. Seven focus groups among mothers, fathers and VHTs (n=56) and key informant interviews (n=9) were conducted. A year-long RCT of 390 pregnant women (3rd trimester) was conducted. Mother-infant dyads were measured for anthropometrics and complementary feeding practices. Barriers to maternal social support included lack of resources, cultural norms, and spousal consensus on roles. Facilitators were community and culture, physical and tangible support, social support structures, support sources, and extended postpartum rest. Perceptions were social interactions, financial support, advice and counseling, and mothers feeling some level of support. There was a positive effect on the introduction of solid, semi-solid, or soft foods (ISSSF) in the Moms-only arm at both Midline-II (AOR=4.0) and Endline (AOR = 3.8). Likewise, ISSSF was better for the Moms & Dads arm at both Midline-II (AOR= 4.5) and Endline (AOR=3.4) periods. Minimum dietary diversity(MDD) was significantly better at the endline only for the Moms & Dads’ arm (AOR=3.0). Minimum acceptable diet (MAD) was significantly better at Endline only for both Moms-only (AOR=2.3) and Moms & Dads’ arms (AOR=2.7). Infant consumption of eggs and flesh foods (EFF) was improved only in the Moms & Dads arm at both Midline-II (AOR=3.3) and Endline (AOR=2.4) periods. Higher maternal social support was associated with better infant MDD (AOR=3.3), MAD (AOR=3.6), and EFF (AOR=4.7). There were significant interaction effects of the Care Group intervention and maternal social support by time on infant mean LAZ (F (6, 560) = 28.91, p < 0.001), WAZ (F (5.8, 539.4) = 12.70, p = < 0.001) and WLZ (F (5.3, 492.5) = 3.38, p = 0.004). By Endline, the intervention improved infant mean LAZ (Moms-only vs Control (mean difference, MD) = 2.05, p < 0.001; Moms & Dads vs Control, MD = 2.00, p < 0.001) and WAZ (Moms-only vs Control, MD=1.27, p < 0.001 ; Moms & Dads vs control, MD=1.28, p < 0.001).
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- OSU Dissertations [11222]