“My Testimony is the Growth of My Baby:” Effectiveness of the Nutrition Improvement Program on Infant and Young Child Feeding and Nutritional Status

Background International consensus to address maternal and child undernutrition is growing since sluggish improvement was an underlying factor in the diminished achievement of the Millennium Development Goals 4 and 5. Despite renewed international focus on nutrition, little attention is paid to nutrition capacity development. Although infant feeding counselling by health workers increases caregivers’ knowledge and improve breastfeeding, complementary feeding, and improve children's linear growth and weight gain, most of the counselling in sub‐Saharan Africa is primarily conducted by mid‐level nurses or community volunteers, and little is done to develop capacity for nutrition at the professional, organizational, or systemic levels. Since 2007, the Cameroon Baptist Convention Health Services (CBCHS) Nutrition Improvement Program (NIP) has trained and integrated a cadre of nutrition counselors into prevention of mother‐to‐child transmission of HIV programs, infant welfare clinics (IWCs), and antenatal clinics to improve infant and young child feeding (IYCF) practices. Study Objective To evaluate the NIP approach by quantitatively measuring the effects of NIP's infant feeding counselors on exclusive breastfeeding (EBF), complementary feeding (CF), children's linear growth (weight for height, height for age) and the benefits of scaling up NIP to other regions of Cameroon. Methods A cross‐sectional evaluation design was used. Using systematic random sampling, caregivers were recruited from NIP sites (n=359) and non‐NIP sites (n=424) at IWCs in the Northwest (NWR) and Southwest Regions (SWR) of Cameroon between October 2014‐April 2015. Caregivers completed a survey to determine EBF and CF practices and their children's weight and height. Differences in EBF and CF practices and children's linear growth between NIP and non‐NIP sites were determined using chi‐square and multiple logistic regression. OneHealth software was used to determine the reduced risk of mortality in children under 5. Results Children 0–5 months at NIP sites were significantly more likely to be exclusively breastfed (90.3% vs. 56%, X 2 = 19.36, p=0.00) and wasted (9.7% vs. 1.3%, X 2 = 4.87, p=. 03) compared to children at non‐NIP sites. Children 6–8 months were significantly less likely to be stunted at NIP compared to non‐NIP sites (12.8% vs. 48.2%, X 2 =92.41, p=0.00). No significant differences in complementary feeding practices or wasting in children 6–8 months or in stunting in children 0–5 months were detected. If nutrition counseling was scaled up to other health institutions in Cameroon, it is likely that exclusive breastfeeding rates would increase, potentially preventing 1, 364 deaths of Cameroonian children under the age of 5. Conclusion Training a cadre of nutrition counselors is one approach towards increasing human resources to implement nutrition interventions to improve maternal and child nutrition. In this research project, IYCF counseling provided by nutrition counselors was effective in increasing exclusive breastfeeding, but not complementary feeding practices, and reduced the risk of stunting in children 6–8 months. The findings support other research indicating counseling or educational interventions increase exclusive breastfeeding by 43% at day 1, 30% at one month, 90% from 1–5 months, resulting in reduced risk of child stunting. Support or Funding Information DFID