Effect of Dala-Led Behavior Change Communication on Complementary Feeding Practices in Infants and Young Children: A Cluster-Randomized Controlled Trial in Agro-Pastoral Settings of Afar Region, Ethiopia.

Suboptimal complementary feeding remains a major public health concern in Ethiopia, particularly among pastoralist and agro-pastoral communities where mobile livelihoods hinder access to conventional health services. In these settings, numerous studies have highlighted the potential of leveraging culturally embedded leadership structures to enhance health promotion efforts. This study examined whether engaging traditional Dala leaders as agents of Nutrition Behavior Change Communication (DALA-BCC) could improve complementary feeding indicators among infants and young children in the agro-pastoral areas of northern Ethiopia. A cluster-randomized controlled trial was conducted in Dubti District, Afar Region, involving 16 non-adjacent clusters randomly assigned to intervention and control arms (eight each). A total of 474 mother-infant pairs (237 per arm) were enrolled at 6-17 months of age and followed over 6 months. Over a 6-month period, the intervention group received DALA-BCC delivered by Dala leaders, consisting of monthly group sessions and cooking demonstrations during the first 3 months, followed by home-based individualized counseling from Month 3 to Month 6, while the control group continued usual care. Core infant and young child feeding (IYCF) indicators were measured at baseline and endline. At end line, the intervention group achieved higher rates of minimum dietary diversity (MDD) (39.7% vs. 24.7%; p = 0.001), minimum meal frequency (MMF) (67.9% vs. 47.6%; p < 0.001), and minimum acceptable diet (MAD) (28.6% vs. 12.1%; p < 0.001). Generalized estimating equation (GEE) analysis showed significant time × group interactions, indicating greater improvements in the intervention group for MDD (RR = 2.43; 95% CI: 1.35-4.39), MMF (RR = 2.08; 95% CI: 1.25-3.48), and MAD (RR = 2.35; 95% CI: 1.10-5.04). The findings demonstrate that the DALA-BCC intervention significantly improved complementary feeding practices, highlighting the effectiveness of culturally grounded, community-led nutrition strategies in Agro-pastoral settings. TRIAL REGISTRATION: PACTR202311816542918. Registered 10 November 2023.