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OBJECTIVES: The objective of this study was to measure the effects of a social behavior change communication (SBCC) intervention on fathers’ and mothers’ complementary feeding knowledge and attitudes, fathers’ support for complementary feeding, and children's dietary diversity and meal frequency. METHODS: This study used cross-sectional surveys of cohabiting fathers and mothers with a child 6–23 months before (N = 497) and after (N = 495) the intervention in Igabi local government area, Kaduna State, Nigeria. Participants were randomly sampled within 99 clusters selected proportional to population size. Regression models weighted for the survey design, including inverse propensity weights to adjust for differences in sociodemographic characteristics of the cross-sections, were used to assess before/after differences. Alive & Thrive's 12-month intervention engaged fathers through community meetings, religious services, and mobile phone text and voice messages. Mothers received home visits from community health extension workers (CHEWs), which fathers also could attend. SBCC materials included TV and radio messages, sermon guides, counseling cards, pamphlets, posters, and feeding bowls. RESULTS: Exposure of fathers to CHEW visits, fathers and mothers to mass media messages, and fathers to text/voice messages increased from baseline to endline. Fathers’ and mothers’ knowledge of the timing of introduction of different foods and meal frequency shifted toward the global recommendations. Fathers’ support for child feeding by providing money for food increased (79% to 90%, P

OBJECTIVES: Eggs are nutrient-rich and have the potential to improve maternal nutrition during pregnancy and birth outcomes, but cultural beliefs may inhibit consumption during pregnancy. This study sought to understand pregnant women's and key influencers’ knowledge, attitudes, beliefs, and practices as well as facilitators and barriers related to consuming eggs during pregnancy in Kenya. METHODS: The study was conducted in an urban (Nairobi) and rural (Kiambu) area, had 3 phases and primarily used mixed qualitative methods to triangulate data. Phase I included in-depth interviews, 24-hour dietary recall, and free-listing and pile-sorting exercises with pregnant women (n = 36), husbands (n = 12) and mothers-in-law (n = 12) of pregnant women, and health workers (n = 24). Phase II involved egg preparation exercises with pregnant women (n = 39). Phase III involved a week-long trial of egg consumption with pregnant women (n = 24). We used thematic content analysis methods to analyze qualitative data and tabulated quantitative data. RESULTS: All participants recognized eggs as nutritious for pregnant women and their unborn children, though only 25% of pregnant women consumed eggs the previous day. Participants believed eating too many eggs during pregnancy (1 or more eggs daily) leads to a large baby and complications during delivery. Unaffordability and unavailability of eggs also inhibit consumption. Health workers are the most trusted source of information on maternal nutrition, while other pregnant and nonpregnant women in the community were cited as those who most often discourage egg consumption. Fried and boiled eggs are the most common and preferred preparation methods due to ease and limited number of ingredients. Almost all women complied with the household trial, said they would continue eating eggs during pregnancy, and would recommend consuming eggs in moderation to other pregnant women. CONCLUSIONS: Although participants believed consuming eggs during pregnancy is beneficial, cultural norms, practices, and beliefs may prevent pregnant women from eating them daily. Interpersonal communication from health workers and agricultural policies to promote affordability could lead to increased consumption, which in turn could have potential positive impacts on maternal nutrition and birth outcomes. FUNDING SOURCES: RTI International.

OBJECTIVES: Interventions to improve breastfeeding practices have not been tested in private facilities in Nigeria, although most urban facilities are private. The objective of this study was to measure the impact of Alive & Thrive's intervention on breastfeeding intentions, early initiation of breastfeeding, and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria. METHODS: The intervention included breastfeeding interpersonal communication during facility visits, breastfeeding text/WhatsApp messages, WhatsApp support groups, and social behavior change communication materials. Logistic regression models adjusted for clustering were used to detect differences in a cohort of women (N = 1,200) at 10 intervention and 10 comparison facilities interviewed during their third trimester and at 6 and 24 weeks postpartum. RESULTS: During pregnancy, intention to exclusively breastfeed at 6 weeks postpartum was 92% in both study arms, but more women in the intervention than comparison arm intended to exclusively breastfeed at 24 weeks postpartum (78% intervention, 64% comparison, p

OBJECTIVES: Easy-to-use tools to facilitate portion size estimation in low-income countries are needed. The objective of this study was to validate digitally displayed photographic portion size estimation aids (PSEAs) against a weighed meal record and compare findings with an atlas of printed photographic PSEAs and actual prepared food PSEAs in a low-income country. METHODS: In Blantyre and Chikwawa Districts, Malawi, we enrolled 300 women 18–45 years of age equally divided by urban/rural residence and years of education (≤4 years and >4 years). Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEAs in a randomized order. RESULTS: Responses for digital and printed PSEAs were highly correlated (>91% agreement for all foods, Cohen's κ = 0.78–0.93). Overall, digital and actual-food PSEAs had a similar level of agreement with the weighed meal record at the group level. The proportion of participants who estimated within 20% of the weighed grams of food consumed ranged by type of food from 30–45% for digital PSEAs and 40–56% for actual food PSEAs. Digital PSEAs consistently underestimated grams and nutrients across foods, whereas actual-food PSEAs provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level. CONCLUSIONS: Digital PSEAs require further testing in low-income settings to improve accuracy of estimations because they offer several logistical advantages over other PSEAs. FUNDING SOURCES: RTI International.