Impact of Behavior Change Communication and Small-Quantity-Lipid-Based Nutrient Supplementation on Nutrient Intake and Adequacy among 12-Month-Old Infants in Rural Zimbabwe: Substudy of a Cluster-Randomized Trial.

BACKGROUND

Poor complementary feeding practices between 6 and 24 mo are a major driver of infant undernutrition. We evaluated an infant and young child feeding (IYCF) intervention combining behavior change communication (BCC) and small-quantity-lipid-based nutrient supplement (SQ-LNS) within the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial in rural Zimbabwe.

OBJECTIVES

We aimed to assess the impact of the IYCF intervention on infant nutrient intake from complementary foods assessed by 24-h dietary recall.

METHODS

The SHINE trial was a cluster-randomized 2 × 2 factorial trial assessing individual and combined effects of IYCF and water, sanitation, and hygiene (WASH) interventions on stunting and anemia in rural Zimbabwe (NCT01824940). We conducted multipass 24-h dietary recalls among 194 randomly selected caregivers of 12-mo-old infants. Nutrient intake and adequacy were compared between children in the IYCF intervention arms (BCC + daily SQ-LNS; n = 99) and non-IYCF arms (standard of care with or without WASH; n = 94), with analyses conducted both including and excluding the contribution of SQ-LNS-derived nutrients, using the measurement-error method.

RESULTS

Energy intake was higher in IYCF compared with non-IYCF infants [531 (404) compared with 426 (272) kcal/d; P = 0.03]. IYCF infants had greater micronutrient intake and adequacy (vitamin A, folate, calcium, iron and zinc; all P < 0.01). However, many children still did not meet their dietary requirements, particularly for calcium and folate. Intakes of all macronutrients and micronutrients from nonsupplement foods did not differ significantly between the IYCF and non-IYCF groups, which suggests that the SQ-LNS provided all the nutritional benefit and did not replace nonsupplement food intake.

CONCLUSIONS

The IYCF intervention improved energy and micronutrient intake and improved micronutrient adequacy, primarily through SQ-LNS, with no displacement of other food intake. However, no differences in intake from nonsupplement foods were observed, indicating that BCC alone had no effect on complementary feeding. This trial was registered at clinicaltrials.gov as NCT01883193 (https://clinicaltrials.gov/study/NCT01824940).