Effectiveness of Behavior Change Communication in Improving Feeding Practices, Nutritional and Health Status of Infants

Globally, about 40% of death children less than two years is associated with inappropriate feeding practices. Optimal breastfeeding and appropriate complementary feeding could prevent 13% and 6% under-five mortality, respectively. Over two third of malnutrition is associated with inappropriate feeding practices during the first year of life.

Every day, 3000-4000 infants die in the developing world from diarrhea and acute respiratory infections because they are given inadequate amounts of breast milk. More than 10 million children die each year in sub- Saharan Africa and South Asia. A major contributor to their deaths is poor breastfeeding practice. The risk of death from diarrhea of partially breastfed infants 0 - 6 months of age was 8.6 times the risk for exclusively breastfed children.

Infant and young feeding practices for infant and young children worldwide are not optimal. It is only 34.8% of infants are exclusively breastfed worldwide. Complementary foods are often introduced too early or too late and are often nutritionally inadequate or unsafe. Only about 39% of infants in the developing countries, 25% in Africa are exclusively breastfed for the first six months and 6% of infants in developing countries are never breastfed.

A wide range of harmful infant and young child feeding practices were documented in Ethiopia. According to EDHS of 2011, 52% of infants started breastfeeding within one hour of birth and exclusive breastfeeding during the first six months with the 4.2 months mean duration of exclusive breastfeeding. About half (49%) of children aged 6-8 months consumed solid, semi-solid, or soft foods and 5% of children were fed minimum dietary diversity and 4% of children fed minimum meal frequency per day while 96% of children continued breastfeeding at one year, and 82% continued at 2 year. Only 4% of children 6 - 23 months living with their mothers are fed in accordance with infant and young child feeding practices and 66% children under the age of two receive age-appropriate breastfeeding. Overall, nearly three children in every ten (27%) are given prelacteal feeds within the first three days of life.

In Amhara region, 38% of infants started breastfeeding within one hour of birth while only 2% and 34% of children 6-24 months were fed according to the minimum standards with respect to food diversity (four or more food groups) and meal frequency.

Sub-optimal infant and young child feeding practices are associated with caretakers' poor knowledge, lack of information and being restricted by traditional beliefs. It is essential to give caregivers necessary knowledge and information to alter their inappropriate feeding behaviors. Promotion of appropriate feeding practices, therefore, is fundamentally important in reducing child malnutrition and mortality and, thus, for achieving MDG 1. In order to sustain the gains made by promoting exclusive breastfeeding for the first six months of life, interventions need to extend into the second half of infancy and beyond. This could be ensured by enabling caregivers to appropriately feed their children with safe and adequate complementary foods while maintaining frequent breastfeeding.

Several efforts to improve the feeding status of the infant and young children have been carried out at different times. The Ethiopian government developed the infant and young child feeding guideline in 2004 following WHO recommendations of global strategy for feeding infants and young children for proper nutrition \& health. Community based nutrition program was also designed to build upon the HEP packages and implemented in all agrarian regions of Ethiopia. However, these efforts have failed to bring about substantive and sustainable changes leading to improvement of infant and young child feeding practices since efforts (nutrition actions) were not based on the evidence on existing feeding practices and what works and what does not. Moreover, the health extension workers were not effectively networked with the community volunteers, work load for health extension workers and lack of training and supervision outcomes could factor their effects on the feeding practices.

As a result, the problem of stunting has remained pervasively high in the country. The government has designed an accelerated stunting reduction program under the revised national nutrition program. Moreover the Federal Ministry of Health has made reduction of child malnutrition in Ethiopia a priority flagship program under the commitment to the Seqota declaration, which states zero level hunger among under two children by 2030. Therefore, the aim of this study is to evaluate the effectiveness of behavior change communication on optimal complementary feeding through community level actors in improving feeding practice, nutrition and health status of infants.