Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study

Objective: To introduce practices for improving complementary feeding and evaluate their adoption and association with improved dietary intakes. Design: A quasiexperimental pilot study comparing dietary intakes from complementary foods among three intervention communities and one control community before and after the intervention, and adoption of new complementary feeding practices among intervention communities following the intervention. Setting: Rural subsistence communities in southern Malawi, Central Africa. Subjects: Mothers and their children aged 6 to 23 months receiving complementary foods. Interventions: A participatory, nutrition education intervention based on four locally adapted lessons for complementary feeding practices designed to increase: (i) total complementary food intake; (ii) energy and nutrient density of the complementary diet, and; (iii) iron and zinc bioavailability of the complementary diet. Results: Adoption rates for the four practices ranged from 25% for preparation of enriched porridges, to 10% for preparing soaked, pounded maize. The amount of complementary foods (g/day) and intakes of energy, animal protein, niacin, riboflavin, calcium, iron, and zinc, but not vitamin A, were significantly greater (P < 0.05) in the intervention compared to control group, as were the energy, iron, and riboflavin density, and the estimated amount of bioavailable iron and zinc. Conclusions: Several intervention practices were well accepted and adopted and were associated with improved adequacy of energy and nutrient intakes from the complementary diet. Such improvements were attributed mainly to greater total intakes and, to a lesser extent, enhanced dietary quality of the complementary foods.