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Assessing the Effect of Voice Messaging to Improve Complementary Feeding Experience among Children 6-23 months in Rural Rwanda a quasi-experimental study

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Summary

USAID/Rwanda's flagship nutrition project, Gikuriro, piloted interactive voice response technology to deliver voice messages on complementary feeding (CF) to caregivers with children 6-23 months of age for three months in order to measure its additive advantage on CF knowledge and practices compared to interpersonal messaging alone. The quasi-experimental study included 110 women with children 6-23 months in the intervention and 110 as comparison in two separate districts. The proportion of mothers with correct knowledge on minimum dietary diversity(MDD) increased from 68 % to 76 % in the intervention district (p< 0.001) versus 66% to 71% (p=0.01) in the comparison district. Correct knowledge on minimum meal frequency(MMF) increased from 69% to 81% for the intervention district (p< 0.001) versus 60% to 65%(p=0.35) in the comparison district. Children receiving MDD increased from 42.3% to 59.3% in the intervention district(p=0.15) compared to 36.5% to 50.9% in the comparison district (p=0.38). Children receiving MMF increased from 23% to 36% in intervention district(p=0.04) versus 30% to 40.9% (p=0.06) in the comparison district.

Minimum acceptable diet (MAD) increased from 15.7% to 19.4% in the intervention district(p=0.5) versus 19.2% to 22.1% (p=0.1) in the comparison district. Interpersonal messaging through community volunteers can increase knowledge and practices related to CF, confirming the relevance of Gikuriro's current approach. Combining voice messaging with IPC had marginal advantage over IPC only approach in increasing knowledge on MMF. Practical gains in CF knowledge and practice from this 3-month study were comparable to three years' results at national level.USAID/Rwanda's flagship nutrition project, Gikuriro, delivers integrated nutrition activities in eight districts to address under five malnutrition. The program empowers community volunteers to deliver nutrition messages to promote positive complementary feeding behaviors. Village nutrition schools, home visits and growth monitoring sites are utilized to deliver and amplify key messages. mHealth is viewed as a promising communication channel that offers the potential to improve healthcare delivery and promote behavior change. Gikuriro piloted interactive voice response (IVR) technology to deliver voice messages to caregivers with children 6-23 months to measure its additive value to other SBC activities promoting CF knowledge and practices.

 

Background/Objectives

USAID/Rwanda's flagship nutrition project, Gikuriro, delivers integrated nutrition activities in eight districts to address under five malnutrition. The program empowers community volunteers to deliver nutrition messages to promote positive complementary feeding behaviors. Village nutrition schools, home visits and growth monitoring sites are utilized to deliver and amplify key messages. mHealth is viewed as a promising communication channel that offers the potential to improve healthcare delivery and promote behavior change. Gikuriro piloted interactive voice response (IVR) technology to deliver voice messages to caregivers with children 6-23 months to measure its additive value to other SBC activities promoting CF knowledge and practices.

 

Description Of Intervention And/or Methods/Design

A quasi-experimental study design was used to enroll 110 women with children aged 6-23 months in the intervention group from Ngoma district and another 110 women as a comparison from Kayonza district in the Eastern Province of Rwanda. 12 messages on dietary diversity and meal frequency that were derived from the MoH validated nutrition counseling card were voice-recorded in Kinyarwanda. Each message was delivered to the intervention participants using Viamo's IVR on their preferred day and time over the course of 12 weeks. Community volunteers in both intervention and comparison districts delivered messages on similar topics through interpersonal communication using key contact points during the same period. Baseline and end line surveys were conducted using structured questionnaire on a digital platform and results were analyzed using SPSS version 20. Comparative analysis was made to assess any differences in complementary feeding knowledge and practices between the two groups.

 

Results/Lessons Learned

The proportion of mothers with correct knowledge of MDD for children 6-23 months increased from 68% to 76% in the intervention district (p< 0.001) versus 66% to 71% (p=0.01) in the comparison. Correct knowledge of MMF increased from 69% to 81% in the intervention district (p< 0.001) and from 60% to 65% (p=0.35) in the comparison. The percent of children 6-23 months who received MDD increased from 42.3% to 59.3% in the intervention district (p=0.15) and 36.5% to 50.9% in the comparison (p=0.38). Similarly, children who received MMF increased from 23% to 36% in intervention district (p=0.04) compared to 30% to 40.9% (p=0.06) in the comparison. Minimum acceptable diet (MAD) increased from 15.7% to 19.4% in the intervention district (p=0.5) compared to 19.2% to 22.1% (p=0.1) in the comparison. Whilst analysis demonstrated that IVR was associated with significant increases in knowledge, it did not show significant changes in behavior

 

Discussion/Implications For The Field

Interpersonal messaging through community volunteers can increase knowledge and practices related to CF, confirming the relevance of Gikuriro's current approach. Combining voice messaging with IPC provided some advantage over an IPC only approach in increasing knowledge, however neither approach increased MDD or MAD. This might suggest the complexity of underlying factors influencing dietary diversity. Practical gains in CF knowledge and practice from this 3-month study were comparable to three years' results at national level. While our data failed to demonstrate strong additive advantages of IVR, the marginal gains demonstrated warrant further research using larger samples and more rigorous methods.

 

Alemayehu Gebremariam - CRS

Collins Lotuk - CRS

Meredith Stakem - CRS

Amy Ellis - CRS

 

Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Centre for Democracy and Development