Abstract:
This study evaluated the effectiveness of a nutrition education intervention for improved child feeding and care giving behaviours of rural mothers of poor farm households of Enugu State, Nigeria, using a positive deviant approach. A cross-sectional quantitative and qualitative survey (using an experimental design) was conducted to identify positive deviant mother-child pairs and their uncommon feeding and care practices. A multistage sampling technique was used in the selection of 198 households. Three communities were randomly selected from the seven autonomous communities in Eha-Amufu. Census of the households residing in the 3 randomly selected communities was conducted to identify 66 eligible households (i.e households with young children 6-24 months of age that is not the only child). Focus group discussion (FGD) and structured questionnaire were used to assess the nutrition knowledge, food related beliefs, child care practices and needs of the mothers. Anthropometric measurements (weights and heights) of the infants were obtained using standard procedures. Based on the results of the nutritional assessment, the community with the most malnourished children was identified and selected for intervention. Positive and non-Positive Deviants (PD and NPD) mothers in the community were also identified. Positive deviant inquiry (PDI) was conducted to discover positive successful care practices in poor households to promote adequate feeding and care practices. The food and nutrient intakes of PD and NPD children were assessed using the weighed food intake method. Internationally accepted cut-off values were used to classify positive and non-positive deviant children. FAO/WHO recommended nutrient intakes (RNI) were used to assess the adequacy of the nutrient intake of the children. The PD care practices were used to develop model curriculum. A simple nutrition education intervention package (NEP) based on the curriculum was developed and pre-tested with a pilot group of women in a similar community not chosen for the intervention. The NEP had ten study components. Three intervention groups, using different combinations of teaching methods: Standard care (SC), Standard care/intensive nutrition counseling/education (SC/INC/E) and Standard care/intensive nutrition counseling/education/practical cooking demonstration (SC/INC/E/PCD) were employed. A pre and post evaluation was conducted to evaluate the impact of NEP on NPD mothers’ child care and feeding behaviours. Data obtained were coded and analysed using the Statistical Package for Social Sciences (SPSS), version 17. Descriptive statistics (frequencies, percentages, means and standard deviation) were used to describe childcare and feeding behaviour of mothers. Student t-test was used to test the differences between pre and post intervention behaviours. Chi square test was used for categorical variables to determine effects of some mother characteristics on childcare and feeding behaviours. Analysis of variance (ANOVA) was used to separate and compare means differences. The result showed a high prevalence of malnutrition among the infants; 32.3% were underweight, 47.1% were stunted, 17.0% were wasted. Clinical signs of undernutrition observed were muscle wasting (13.0%), scanty and discoloured hair (9.1%) and xerosis (5.1%). FGD results revealed several food related beliefs as well as lack of nutrition knowledge in the selecting of appropriate foods for infants, poor concept of exclusive breastfeeding and the belief that poverty is a limiting factor for exclusive breast feeding. Although the intake of energy, calcium, thiamin, riboflavin and ascorbic acid were limited for all the infants, PD children still had significantly (p<0.05) higher intakes of these nutrients than NPD children and all the PD children met their requirements for all other nutrients. NPD infants (6-12months) only met their requirements for vitamin A (101.12%) and thiamin (103.33%). Other distinguishing characteristics of PD mothers and their infants included: higher education, practice of exclusive breast feeding, always emptied their breast during breastfeeding, child accompanying mother to work, deworming of children within the past six months, treated drinking water for their children, and the absence of fever or diarrhea among the infants during the two weeks preceding the interview. There were significant (p<0.05) improvement in the post-test scores in eight (growth monitoring, malnutrition, selection of body building and protective foods, infant nutrition, diarrhea, family planning and feeding during illness) out of the ten components of the NEP among mother in the SC/INC/E/PCD group compared to the improvement in one (family planning) and four (growth monitoring, selection of body building and protective foods, and immunization) components of mothers in the SC and SC/INC/E group, respectively. Infants of mothers belonging to the SC/INC/E/PCD had a significantly higher percentage weight increase (5%) compared to an increase of 2.56% in the SC/INC/E group and a decrease of 4% in the SC group. The changes in height were minimal and with no significant differences among the groups (0.4% for SC, 0.6% for SC/INC/E and 0.8% for SC/INC/E/PCD). Identification and use of positive deviant mothers (as change agents) to teach the non-positive deviants in rural communities for acceptable and sustainable impact is recommended.
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