Theory-driven process evaluation of a complementary feeding trial in four countries.

Academic Article

Abstract

  • We conducted a theory-driven process evaluation of a cluster randomized controlled trial comparing two types of complementary feeding (meat versus fortified cereal) on infant growth in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo. We examined process evaluation indicators for the entire study cohort (N = 1236) using chi-square tests to examine differences between treatment groups. We administered exit interviews to 219 caregivers and 45 intervention staff to explore why caregivers may or may not have performed suggested infant feeding behaviors. Multivariate regression analysis was used to determine the relationship between caregiver scores and infant linear growth velocity. As message recall increased, irrespective of treatment group, linear growth velocity increased when controlling for other factors (P < 0.05), emphasizing the importance of study messages. Our detailed process evaluation revealed few differences between treatment groups, giving us confidence that the main trial's lack of effect to reverse the progression of stunting cannot be explained by differences between groups or inconsistencies in protocol implementation. These findings add to an emerging body of literature suggesting limited impact on stunting of interventions initiated during the period of complementary feeding in impoverished environments. The early onset and steady progression support the provision of earlier and comprehensive interventions.
  • Published In

    Keywords

  • Caregivers, Child Development, Democratic Republic of the Congo, Female, Guatemala, Health Education, Humans, Infant, Infant Food, Infant Nutritional Physiological Phenomena, Interviews as Topic, Male, Nutritional Status, Pakistan, Program Evaluation, Zambia
  • Digital Object Identifier (doi)

    Author List

  • Newman JE; Garces A; Mazariegos M; Michael Hambidge K; Manasyan A; Tshefu A; Lokangaka A; Sami N; Carlo WA; Bose CL
  • Start Page

  • 297
  • End Page

  • 305
  • Volume

  • 29
  • Issue

  • 2