Effectiveness of a multifaceted intervention for the improvement of nutritional status and nutrition knowledge of children in poverty-stricken areas in Shaanxi Province, China

Objectives:Compare the differences between the intervention and control groups in changes of primary outcomes(body mass index[BMI]and waist-to-height ratio[WHtR])and secondary outcomes(nutrition knowledge of children and parents),from baseline to the 6-and 12-month follow-ups;examine the associations of changes in nutrition knowledge of children and their parents with children’s changes in BMI and WHtR.Data sources:Data collected from four schools in two poverty-stricken counties in northern Shaanxi Province in 2020‒2021.Methods:A multifaced intervention program targeted children(promoting healthy diet and nutrition education)and their parents(promoting nutrition knowledge)was conducted in the interventional group.Four schools,with two in each group,were randomly allocated to the intervention or control group,with 814 eligible children aged 7.1 to 12.8 years.The control group conducted myopia promotion.Differences in changes of BMI and WHtR between groups were compared with t-test.Mixed-effects model was used to examine the associations between changes in nutrition knowledge of children and parents with changes in children’s BMI and WHtR.Results:At the 6-month follow-up,the difference in changes in BMI between the intervention and control groups was 0.4 kg/m 2(P<0.001).At the 12-month follow-up,the difference in changes in BMI and WHtR between intervention and control groups was 0.1 kg/m^(2)(P<0.001)and 0.01 kg/m^(2)(P<0.001).In the intervention group,the nutrition knowledge awareness rate of children increased from 16.9%(69/409)at baseline to 21.3%(87/409)at 6-month,and 22.7%(93/409)at 12-month.The awareness rate of nutrition knowledge of parents also fluctuated,from 5.6%(23/409)to 6.6%(27/409)and 5.4%(22/409).However,the difference in changes in nutrition knowledge between intervention and control groups was non-significant.The 6-month follow-up changes in children’s nutrition knowledge scores were negatively associated with changes in BMI in girls(β=−0.26,95%confidence interval[CI]:−0.38 to−0.14,P<0.001),while positively associated with changes in WHtR in boys(β=0.003,95%CI:−0.0002 to 0.005,P=0.035).The 12-month follow-up changes in children’s nutrition knowledge scores were positively associated with changes in children’s WHtR(β=0.003,95%CI:0.0004 to 0.01,P=0.018).Conclusions:The intervention strategies did not reduce the BMI and WHtR of children,and the nutrition knowledge of children and parents increased after the intervention in intervention group.Changes in nutrition knowledge of children and their parents are associated with changes in children’s BMI or WHtR.Interventions with a new focus on obesity are needed to help improve children’s nutritional status in poverty-stricken areas in Shaanxi Province of China.

Effect of a Nutrition Education Intervention on Mothers’ Infant and Young Child Feeding Knowledge and Practices in the Peri-Urban Areas of Bobo-Dioulasso: Before and after Study

Background: This study assessed the effect of a nutrition education intervention aiming to improve the knowledge and practices of under 5 years children’s mothers on infant and young child feeding in peri urban areas of Bobo-Dioulasso in Burkina Faso. Methods: A total of 243 mothers of children under 5 years in the peri-urban of Bobo-Dioulasso were surveyed before and after the intervention using the FAO questionnaire for infant and young child feeding (IYCF) knowledge and practices assessment in January and October 2017. The intervention included two components consisting of a theoretical phase (counselling and discussion) and cooking demonstrations implemented for ten months. To account for the before-and-after design of the study, the McNemar’s test was used to assess the effect of the intervention on mothers’ infant and young child feeding knowledge and practices. Results: The mean age of mothers was 29 ± 6.2 years and 50.6% of the mothers were between 20 and 29 years old. All indicators used to assess the mothers’ knowledge of breastfeeding and complementary feeding significantly improved after the intervention (all p-values < 0.05). In terms of child feeding practices, half of the indicators (early breastfeeding initiation, age of complementary feeding initiation, and minimum meal frequency) significantly increased (all p = 0.001) while two indicators (minimum dietary diversity, and minimum acceptable diet) did not change (p = 0.06 and 0.67) after the intervention. Finally, continued breastfeeding, significantly declined after the intervention (73.3% vs 86.0% p = 0.001). Conclusion: The intervention improved the mothers’ knowledge on breastfeeding and complementary feeding and some child feeding practices. This study provided some evidence of an effective nutrition education intervention to increase maternal knowledge and practices.

Evaluation of the Coordinated Approach to Child Health (CATCH) Program in Third through Fifth Graders in Northern Illinois

Background: The Coordinated Approach to Child Health (CATCH) is a school-based health education program, grounded in Social Cognitive Theory (SCT), and designed to improve dietary habits and increase physical activity among children and adolescents. The objective of this study was to evaluate the effectiveness of CATCH program, delivered by dietetic interns and Northern Illinois University (NIU) students, to 3rd-5th graders in Northern Illinois, in increasing their nutrition knowledge and healthy choices behavior. Methods: In total, 167 elementary school children in grades 3 - 5 in Northern Illinois participated in a non-experimental program evaluation study. We delivered 6 CATCH lessons throughout the academic year to five elementary schools. Lessons were focused on “Go, Slow, and Whoa” food categories to help children understand healthier food choices. Validated questionnaires from the CATCH Global Foundation were administered in classrooms and online, pre/post intervention, to assess nutritional knowledge and healthy choices. Results: Children in third through fifth grades significantly increased their knowledge about nutrient dense foods, p < 0.001, p < 0.001, p < 0.001, respectively. Fourth and fifth graders exhibited a significant increase in their ability to make healthier food choices, p = 0.03 and p = 0.007, respectively. As grade level increased from third to fifth grade, improvement in nutrition knowledge and adoption of healthy food choices did not increase significantly, p = 0.973 and p = 0.637, respectively. Conclusion: We conclude that children in grades 3 - 5 who participated in the 6 lessons of the CATCH program expanded their nutritional knowledge and 4th and 5th graders improved their ability to make healthier choices. Conducting evaluations of health promotion programs is imperative to determine the impact of the program, as well as to explore possible improvements in content and delivery for future implementation.