Health Extension Workers' Knowledge and Knowledge-Sharing Effectiveness of Optimal Infant and Young Child Feeding Are Associated With Mothers' Knowledge and Child Stunting in Rural Ethiopia

Background: Little is known about how the knowledge and the knowledge-sharing effectiveness (KSE) of health extension workers (HEWs) affect maternal knowledge of optimal infant and young child feeding (IYCF) and their child's nutritional status. Objective: The objective of this study was to evaluate mothers' and HEWs' knowledge of key IYCF practices and to investigate whether mothers' knowledge and HEWs' KSE are associated with stunting in young children (aged 12-23 months). Methods: This cross-sectional study used face-to-face interviews to assess the IYCF knowledge of HEWs (n = 96) and mothers of 12- to 23-month-old children (n = 122) in Mecha district, West Gojam, Ethiopia. The association between HEWs' KSE and children's length-for-age z scores (LAZ) was investigated. Results: Stunting (50%), underweight (34%), and wasting (10%) were highly prevalent. Less than half (45%) of the mothers had access to nutrition education through the health extension program, but those who had, had better knowledge of IYCF practices and thus lower rates of stunting (P < .001). However, key IYCF practices were not well understood by the HEWs and this affected their KSE. The gap in KSE was negatively associated with LAZ (r = -.475, P < .001) and remained significant even after adjusting for maternal height, socioeconomic status, and maternal education (r = -.423, P = .002). Conclusion: Health extension workers' KSE is associated with child stunting. Future training of HEWs would benefit from emphasis on not only the content of the IYCF messages but also the process of delivery while increasing their counseling skills.