Impact of Harvest Lentil Vegetable Blend and Nutrition Education on Turkana Children's Health Outcomes

Child's height was measured using Shorr Board® measuring board. For children below 24 months, their lying length was measured. For children older than 24 months, their standing height was taken . Height measurements were recorded to the nearest 0.1cm.

height-for-age (HAZ) were computed using the WHO Anthro Survey Analyzer software.

Weight-for-age z-scores (WAZ) were computed using the WHO Anthro Survey Analyzer software.

Weight-for-height z-scores (WHZ) were computed using the WHO Anthro Survey Analyzer software.

Children were classified as stunted if their HAZ were below -2 SD the WHO Child Growth Standards

Children were classified as underweight if their WAZ were below -2 SD the WHO Child Growth Standards

Children were classified as wasted if their WHZ were below -2 SD the WHO Child Growth Standards

Children were classified as co-currently stunted and wasted if their HAZ and WHZ wew below -2 SD the WHO Child Growth Standards

The meal frequency was calculated by summing all the feedings a child consumed throughout the day, including solid, semi-solid or soft foods, as well as milk feeds for non-breastfed children. The proportion of children meeting the minimum meal frequency (MMF) was computed among children aged 6-23 months. Per the WHO and UNICEF guidelines, the recommended age-appropriate meal frequency varies both by child's age and breastfeeding status. The recommended MMF is two feedings for breastfed children aged 6-8 months, three feedings for breastfed children 9-23 months, and four feedings for non-breastfed children 6-23 months .

To assess children's dietary diversity, caregivers were asked if their children consumed food from the following eight foods groups: (i) breastmilk, (ii) grains, roots, and tubbers (iii) pulses, nuts, and seeds, (iv) dairy products, (v) flesh foods, (vi) eggs, (vii) vitamin-A-rich fruits and vegetables, and (viii) other fruits and vegetables . A food group was assigned a score of one if a child consumed at least one food item from that group; otherwise, it was scored as zero. To calculate the dietary diversity scores, all the food groups consumed were added up. The maximum possible score was eight food groups for children aged 6-23 months and seven food groups for children 24-59 months (excluding breastmilk). A child was considered to have met the minimum dietary diversity if they consumed at least five food groups for ages 6-23 months and at least four food groups for ages 24-59 months .

The proportion of children consuming ASFs was calculated by dividing the number of children who consumed at least one food item from dairy products, flesh foods and eggs food groups by the total number of children in the sample.

The proportion of children meeting the minimum acceptable diet was calculated among children aged 6-23 months. This is a composite measure of both the dietary diversity and meal frequency . Breastfed children were said to receive minimum acceptable diet if they met both minimum dietary diversity (MDD) and the age-appropriate meal frequency (MMF) . For non-breastfed children they had to meet the MDD, the age-appropriate MMF, and receive at least two milk feeds.

The household WASH practices were assessed using a questionnaire adapted from WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. The assessed WASH practices were: source of drinking water, preparation of drinking water, hand washing at the critical time, proper handwashing technique, sanitation facility and open defecation.

A total of 12 items were used to assess caregivers' knowledge on proper IYCF practices. These items have been adapted from the FAO guidelines for assessing nutrition-related knowledge, attitudes, and practices, and were validated by experts in the Community and International Nutrition Research (CINR) Lab. Each correct question was given a score of one, or else a score of zero was given. All the correct scores were summated to provide an aggregate knowledge score for each participant, with the maximum possible score of 12 points. Knowledge scores were further categorized as low (< 6 points), fair (6 - 8 points), and Adequate (> 8 points).

A total of 13 questions were used to assess caregivers' attitudes towards child feeding practices (e.g.: "Solid foods should be introduced to children at 6 months"). Possible responses to the attitudes' questions were "disagree", "not sure", and "agree". The summated attitude scores were calculated for each caregiver, where responses for each question were scored as follows: "disagree" was assigned a score of one, "not sure" a score of two, and "agree" a score of three. The total maximum possible score was 39 points, with a higher score indicating positive attitudes towards child feeding practices . The attitudes scores were further divided into two categories, attitudes towards breastfeeding practices (possible maximum score was 6 points) and attitudes towards complementary practices (possible maximum score was 33 points).

Caregivers perceived social support on the practice of proper child feeding practices were assessed using five questions (e.g.: "People who are important to me think that I should start giving my child semisolid or solid foods after he/she turns 2 weeks"). The responses to the subjective norms' questions were on a three-point Likert scale of "disagree", "not sure", and "agree". The aggregate subjective norms score was calculated for each caregiver, where those who responded "disagree" were assigned a score of one, "not sure" assigned a score of two, and "agree" assigned a score of three for positively worded questions and the reverse for the negatively worded questions. The possible maximum subjective norms score was 15 points, and the minimum score was five points. Higher score indicated greater perceived social support for adhering to the recommended child feeding practices.

Five items were used to assess caregivers perceived behavioral control (e.g.: "I feel confident feeding my child when he/she is sick"). Caregivers answered on three points- Likert scale of "not confident", "ok/so-so", and "confident". The composite perceived behavioral control score was calculated for each caregiver, with those who responded "not confident" assigned a score of one, "ok/so-so" a score of two, and "confident" a score of three. The possible maximum subjective norms score was 15 points and the minimum score was five points, with higher values indicating high perceived behavioral control

A total of five questions were used to assess caregivers' intentions to practice recommended child feeding practices (e.g.: "I intend to feed my child different types of food"). Possible responses to the attitudes' questions were "disagree", "neither agree nor disagree", and "agree". The summative intentions score was calculated for each caregiver, with those who responded "disagree" assigned a score of one, "neither agree nor disagree" a score of two, and "agree" a score of three. The possible maximum subjective norms score was 15 points, with higher values indicating high motivation to comply to the recommended child feeding practices