Engaging Fathers Through Nutrition Behavior Communication Change Does Not Increase Child Dietary Diversity in a Cluster Randomized Control Trial in Rural Ethiopia

Background: Adding food vouchers or paternal nutrition behavior change communication (BCC) activities to maternal BCC may improve child diets and household food security but their effect is unknown. Objectives: We assessed whether maternal BCC, maternal and paternal BCC, maternal BCC and a food voucher, or maternal and paternal BCC and a food voucher improved nutrition knowledge, child diet diversity scores (CDDS), and household food security. Methods: We implemented a cluster randomized control trial in 92 Ethiopian villages. Treatments were as follows: maternal (M) BCC only; maternal BCC and paternal BCC (M+P); maternal BCC and food vouchers (M+V); and maternal BCC, food vouchers, and paternal BCC (M+V+P). Effects were assessed using generalized estimating equations. Results: Maternal BCC and paternal BCC increased the maternal and paternal knowledge of optimal infant and young child feeding practices by 4.2-6.8 percentage points (P < 0.05) and by 8.3-8.4 percentage points (P < 0.01), respectively. Combining maternal BCC with either paternal BCC or the food voucher increased CDDS by 21.0%-23.1% (P < 0.05). The treatments M, M+V, and M+P increased the proportion of children who met minimum acceptable diet standards by 14.5, 12.8, and 20.1 percentage points, respectively (P < 0.01). Adding paternal BCC to the maternal BCC treatment or to the maternal BCC and voucher treatment did not lead to a larger increase in CDDS. Conclusions: Increased paternal involvement does not necessarily translate into improvements in child feeding outcomes. Understanding the intrahousehold decision-making dynamics that underlie this is an important area for future research. This study was registered at clinicaltrials.gov as NCT 03229629.

Automated summary

This study evaluated the impact of adding paternal nutrition behavior change communication (BCC) activities or food vouchers to maternal BCC on child diets and household food security in Ethiopian villages. The results showed that maternal BCC combined with paternal BCC or food vouchers improved child diet diversity and household food security. However, increasing paternal involvement did not necessarily lead to improvements in child feeding outcomes, suggesting the need for further research.