May, 2017 - SUPPORT Summary of a systematic review | print this article |

Is nutrition training of health workers effective in improving caregivers’ feeding practices for children aged six months to two years?

Caregivers’ feeding practices for children are influenced by different factors that include social and cultural issues. One method that can help overcome these issues is nutrition training of health workers. This is done through in service training, continuing professional education, short courses, or seminars.

Key messages

 

  • Nutrition training of health workers increases daily energy intake of children aged six months to two years.
  • Nutrition training of health workers increases feeding frequency of children less than two years of age.
  • Children whose caregivers are counselled by trained health workers have a higher consumption of targeted food items compared to their counterparts.

Background

Under nutrition is responsible for one third of child deaths worldwide, mainly in low and middle income countries. Nutrition training of relevant health workers can help in reducing this problem mainly through providing frequent nutrition counseling to caregivers. Nutrition training is defined as “any formal nutrition course provided to health workers in the form of in service training, continuing professional education, short courses, or seminars, aimed at improving the nutrition knowledge or practices of health workers.”



About the systematic review underlying this summary

Review objectives: To examine the effectiveness of nutrition training for health workers on child feeding practices among children aged 6 months to 2 years.
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials and cluster randomised trials of interventions in which health workers received nutrition trainings targeting caregivers’ feeding practices.
Ten randomised trials and cluster randomised trials of interventions in which health workers received nutrition training targeting caregivers’ feeding practices.
Participants Health workers including doctors; nurses and nurse midwives; midlevel providers including assistant medical officers, clinical officers, assistant nurses, or assistant physicians; community health workers including village health workers.
Nutritionists (2); doctors (1); health workers (6); community health workers (2); auxiliary nurse midwives (1)
Settings Health facilities
Health facilities in low and middleincome countries: India (4), Brazil (1), Peru (1), Pakistan (1), China (1), Bangladesh (1), Vietnam (1)
Outcomes Three outcome variables: feeding frequency measured in the number of times the child was fed in the previous 24 hours; energy intake in kilojoules (kJ) per day; and dietary diversity, defined as the variety of food items that was fed to a child
Feeding frequency (5), energy intake (6); dietary diversity: consumption of targeted food items (7)
Date of most recent search: October 2012
Limitations: This is a well conducted systematic review with only minor limitations.

Sunguya B, Poudel K, Mlunde L, et al. Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutrition J 2013; 12:66.

 

Sunguya B, Poudel K, Mlunde L, et al. Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutrition J 2013; 12:66

Summary of findings

The review included 10 studies conducted in low and middle income countries. The studies found that health workers receiving nutrition training for caregivers:

 

  • Leads to better energy intake in children aged 6 months to two years. The certainty of this evidence is high.
  • Leads to higher feeding frequency in children aged 6 months to two years. The certainty of this evidence is high.
  • Leads to more consumption of targeted food items in children aged 6 months to two years. The certainty of this evidence is high.
  • No studies reported on the cost of nutrition training or on health outcomes; e.g. the proportion of undernourished children or children with adverse health outcomes.

Health workers who received nutrion training versus health workers who did not receive nutrition training

People: Health workers: nutritionists; doctors; health workers; community health workers; auxiliary nurse midwives.
Settings
:  Health facilities in low and middle income countries: India, Brazil, Peru, Pakistan, China, Bangladesh, Vietnam.
Intervention
: Nutrition training.
Comparison
: No nutrition training.
Outcomes Impact Certainty of the evidence
(GRADE)
Comments
Energy intake in kilo joules (kJ) per day
Standardized mean difference +0.76 (95% CI 0.63 to 0.88)
High
The effect was expressed in units of standard deviations. The results indicate a moderate beneficial effect of the intervention on energy intake 
Feeding frequency (number of times the child was fed in the previous 24 hours)
Standardized mean difference +0.48 (95% CI 0.38 to 0.58)Relative risk of being fed: 0.99 (0.87 to 1.13)
High
 The results indicate a moderate beneficial effect of the intervention on feeding frequency.
Consumption of targeted food items   High There were consistent findings among all included studies showing that children whose caregivers were counseled by trained health workers had a higher consumption of targeted food items compared to their counterparts.
Cost of training No included studies    
Health outcomes, such as the proportion of undernourished children or children with adverse health outcomes No included studies    
GRADE: GRADE Working Group grades of evidence (see above and last page)

 


 

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY
The interventions were conducted in healthcare facilities in low and middle income countries.

The results are likely applicable in low income country settings with accessible health facilities that are utilized by caregivers.

 

  • Nutrition training strategies may differ for different countries, depending on the setting and culture.
  • The availability and type of health professionals may differ in different areas. Methods of training and the training materials should be prepared based on the local context and a mapping of where to receive these counseling sessions and how to identify foods that are available, affordable and acceptable is crucial especially in more rural areas where resources are less available, affordable and access may present an issue.
EQUITY
The systematic review did not address equity issues.
Training targeted at disadvantaged and underserved populations would likely reduce inequities. However, training health workers serving less disadvantaged populations might increase inequities relative to more disadvantaged populations with out access to trained health workers.
ECONOMIC CONSIDERATIONS
The review did not include studies that reported economic evaluations.
There may be some additional costs involved in providing nutrition training to health workers, as well as potentially increased costs associated with providing counseling to the caregivers. Future studies should include economic evaluations, and local costing would be important prior to implementation.
MONITORING & EVALUATION
The certainty of the evidence was high for feeding frequency and energy intake.

Delivery of the intervention and performance of health workers should be monitored when implementing a new nutrition training program. Consideration should also be given to monitoring the impact of the training on caregivers’ behaviors.


*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low income countries. For additional details about how these judgments were made see: www.supportsummaries.org/methods

 

Additional information

Related literature

Kulwa KB, Verstraeten R, Bouckaert KP, et al. Effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth of infants and young children in rural Tanzania: rationale, design and methods of a cluster randomised trial. BMC Public Health 2014; 14.

Sunguya BF, Poudel KC, Mlunde LB, et al. Nutrition training improves health workers' nutrition knowledge and competence to manage child undernutrition: a systematic review. Frontiers Public Health 2013; 1:37.

 

This summary was prepared by

Andrea Darzi, MD, MPH, Clinical Research institute AUB GRADE Centre at the American University of Beirut, Leba non; and Nour Hemadi, MPH, K2P, American University of Beirut, Lebanon

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Agustin Ciapponi and Samar ElFeky. We did not receive any comments from the review authors.

 

This review should be cited as

Sunguya B, Poudel K, Mlunde L, et al. Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutrition J 2013; 12:66.

 

The summary should be cited as

Darzi A, Hemadi N. Is nutrition training of health workers effective in improving caregivers’ feeding practices for children aged six months to two years. A SUPPORT Summary of a systematic review. May 2017. www.supportsummaries.org

 

Keywords

Evidence informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care, nutrition training, health workers, feeding frequency, energy intake



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