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Research
Effects of a home-based participatory play intervention on infant and young child nutrition: a randomised evaluation among low-income households in El Alto, Bolivia
  1. Sebastian Martinez1,
  2. Julia Johannsen1,
  3. Gaston Gertner1,
  4. Jorge Franco1,
  5. Ana B Perez Exposito1,
  6. Rosario M Bartolini2,
  7. Irma Condori3,
  8. Jhovanna Flores Ayllón3,
  9. Ramiro Llanque3,
  10. Nohora Alvarado1,
  11. Christian Lunstedt1,
  12. Cecilia Ferrufino1,
  13. Teresa Reinaga1,
  14. Mauricio Chumacero4,
  15. Carlos Foronda4,
  16. Santiago Albarracin4,
  17. Ana Maria Aguilar5
  1. 1Inter-American Development Bank (IDB), Washington, DC, USA
  2. 2Instituto de Investigación Nutricional, La Molina, Peru
  3. 3Consejo de Salud Rural Andino (CSRA), La Paz, Plurinational State of Bolivia
  4. 4Universidad Privada Boliviana (UPB), Center for Generation of Information and Statistics (CEGIE), La Paz, Plurinational State of Bolivia
  5. 5Universidad Mayor de San Andres (UMSA), La Paz, Plurinational State of Bolivia
  1. Correspondence to Dr Sebastian Martinez; smartinez{at}iadb.org

Abstract

Background Stunting affects child survival and is a key indicator of child well-being. Therefore, reducing stunting is a global goal. Improving infant and young child feeding (IYCF) practices is a recommended approach to reduce the risk of mortality and ameliorate nutritional status. Behavioural change interventions have the potential to improve IYCF practices.

Methods We evaluated the effectiveness of an innovative behavioural change strategy on caregiver’s knowledge, IYCF practices and nutritional status of children from low-income households in El Alto, Bolivia. Home visits used culturally adapted participatory play strategies to promote recommended IYCF practices. A total of 2014 households with children younger than 12 months at baseline were randomly assigned to treatment and control groups.

Findings Caregiver knowledge and IYCF practices improved by 0.2 SD, as did food expenditures on recommended foods and dietary diversity. No significant effects were detected on anthropometric indicators or anaemia. Treatment compliance was 88% of households at enrolment and 66% at completion.

Interpretation Participatory play-based behavioural change strategies are a promising delivery model to improve recommended IYCF practices. After 30 months of intervention, we found sustained positive effects on caregiver’s knowledge and IYCF practices but no effect on nutritional status. Despite the lack of effect on linear growth and anaemia, our results highlight the relevance of implementing interventions that improve IYCF practices due to their importance for early development and prevention of obesity. Other contextual variables, apart from diet, that could be limiting children’s growth potential in this population need to be identified to design holistic approaches that improve child well-being and human capital.

  • nutrition
  • child health
  • maternal health
  • randomised controlled trial

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2017-000687

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors SM, JJ, GG, ABPE, RMB, IC, RL and AMA: conceived and designed the study and discussed, critically revised and approved the study protocol. All authors: wrote the paper, drafted the first version of the report and elaborated, discussed and approved the final version of the report and the paper for publication. SM, JJ, GG, RMB, IC, JFA, RL, NA, CL, CF, TR and AMA: responsible for the organisation and conduct of the study. SM, JJ, GG, NA, CL, TR and AMA: supervised the study. TR, MC, CF and SA: collected the data. SM and JF: responsible for the statistical analysis. JJ, GG, ABPE, RMB and AMA: contributed to the data analysis.

    • Funding Baseline data collection and part of the programme’s implementation costs were funded by the Inter-American Development Bank (IDB) grant BO-T1181 (ATN/JO-13606-BO), ‘Improving Child Nutrition Services in Bolivia’, a technical cooperation project financed through a donation from the IDB’s Japan Special Fund Poverty Reduction Program (JPO) and executed by the CSRA, in coordination with the Ministry of Health and local public health centres in El Alto. Endline data collection was conducted by the Center for Generation of Information and Statistics (CEGIE) at the Bolivian Private University and funded through the IDB grant BO-T1259 (ATN/OC-15554-BO), ‘Effectiveness Of Community Interventions to Reduce Child Malnutrition’, executed by the IDB.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval The evaluation survey was reviewed and approved by the ethical review board of the National Bioethics Committee in Bolivia.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All non-identifiable data will be made available through the Inter-American Development Bank’s publications website.