According to the World Health Organisation, when breast milk is no longer enough to meet the nutritional needs of the infant, complementary foods should be added to the diet of the child.
The transition from exclusive breastfeeding to family foods, referred to as complementary feeding, typically covers the period from six to 18-24 months of age, and It is the time when malnutrition starts in many infants.
Poor infant and young child feeding (IYCF) practices is one of the several factors causing child undernutrition in Vietnam.
“In Vietnam, as elsewhere, strategies to improve IYCF are central to improving child nutrition,” wrote academics in the Journal of Nutrition
“Small-scale efficacy trials to improve complementary feeding, including the provision of nutrition education and/or complementary foods, have shown positive impacts on maternal IYCF knowledge and child feeding practices, but the impacts on child growth are inconsistent.”
In order to tackle the problem in Vietnam, the Alive & Thrive programme, which is funded by the Bill and Melinda Gates Foundation, worked with the government to set-up 781 social franchises within government health facilities in 15 of 63 provinces.
Communities were randomly selected to receive and intensive programme, featuring enhanced counselling, mass media campaigns and community mobilisation strategies, while others received a less intensive implementation of the programme.
Using the brand name MatTri B´e Th (MTBT or ‘‘The Little Sun’’), the facilities had dedicated counselling rooms, trained staff and information materials.
Training and supervision, incentives to the health facilities and monitoring tools were used to improve the quality of services.
“The program aimed to deliver a minimum of nine and a maximum of 15 counselling contacts to each mother-child pair from the last trimester of pregnancy through the child’s first two years of life, among them seven complementary feeding contacts from age six to 24 months” the study revealed.
The media effort consisted of TV and digital media campaigns, with TV spots focusing on promoting iron-rich food consumption of infants from six months onwards.
Community mobilisation efforts in intensive areas involved village health workers visiting households of mothers with children 24 months below to hand out invitation cards, invite them to counselling services, and give women basic complementary feeding information.
The measures of four core WHO complementary feeding indicators (minimum diet diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich foods) improved over time in both the non-intensive and intensive groups. However, there was no differential improvement in favour of the intensive group.
Stunting declines occurred in both groups between baseline and endline, ranging from 5.4 pps in non-intensive group to 7.1 pps in the intensive group.
The researchers also found significantly higher maternal education, maternal and household food diversity, and ownership of a garden among those who had used the services at least once, compared with nonusers.
The academics said their findings provided “rigorous evidence that shows that an innovative social franchising model that is integrated into the government health system in Vietnam and delivered at scale, along with mass media and community mobilisation, improved complementary feeding practices when mothers were exposed to the intervention.”
They concluded: “Given that improvements were observed primarily among the subset of mothers who were exposed to the franchise at least once, it is important to address challenges to improve service utilization in order to achieve full programme impact.”
Source: Journal of Nutrition
“Social franchising and a nationwide mass media campaign increased the prevalence of adequate complementary feeding in Vietnam: A cluster-randomised programme evaluation”
Authors: Rahul Rawat, Phuong Hong Nguyen et al.