Effect of a Facility-Based Nutrition Education Intervention on Nutritional Status of Children Aged 6–23 Months: A Longitudinal Quasi-Experimental Study in Nyeri County, Kenya

Childhood malnutrition remains a major public health challenge in low- and middle-income countries, contributing substantially to morbidity and mortality among children under five. Although nutrition education is widely promoted to improve infant and young child feeding practices, evidence on its effects when delivered through routine health services in Kenya over a nine-month period remains limited. This study evaluated the effect of a structured facility-based nutrition education intervention comprising interactive group sessions with practical food demonstrations on the nutritional status of children aged 6-23 months in Nyeri County, Kenya. A longitudinal quasi-experimental study was conducted between May 2021 and March 2022 in two purposively selected Level IV hospitals (Karatina, intervention; Othaya, control). A total of 451 mothers, each paired with one child (220 intervention, 231 control), were enrolled and followed for nine months (360 retained). Mothers in the intervention arm attended three quarterly sessions of about 60-75 minutes, each pairing interactive learning with hands-on food demonstrations using locally available ingredients and content drawn from the Kenya Ministry of Health Infant and Young Child Nutrition counselling cards. Mothers in the control arm received the facility's routine maternal and child health education. Children's anthropometry was measured at baseline and at 3, 6, and 9 months, and weight-for-length, weight-for-age, and length-for-age Z-scores were derived against the WHO Child Growth Standards to classify wasting, underweight, and stunting. Because each child was measured repeatedly, intervention effects were assessed primarily using generalized estimating equations (GEE) modelling the arm × time interaction, supported by prevalence changes, net intervention effects, and chi-square or Fisher's exact tests, with significance set at 5%. The two arms were comparable in nutritional status at baseline. By nine months, the prevalence of wasting declined from 7.3% to 4.1% in the intervention arm compared with 8.5% to 8.3% in the control arm (net intervention effect − 3.0 percentage points). Generalized estimating equations that accounted for repeated measures within children showed no statistically significant arm × time interactions for wasting (OR 1.01, 95% CI 0.94–1.09, p = 0.73), underweight or stunting. A structured facility-based nutrition education programme integrating food demonstrations was associated with a favourable but non-significant reduction in wasting over the nine-month period. Nutrition education should be strengthened alongside nutrition-sensitive interventions, including improved household food security, water, sanitation and hygiene, and social protection programmes, to achieve sustained improvements in child nutritional status. Key words:nutrition education; facility-based; child nutritional status; quasi-experimental study; net-effect intervention; generalized estimating equations; Nyeri; Kenya