Peer Support Improves Infant Nutrition And Growth Among Refugees Mothers In The West- Nile Region, Uganda

Published: 21 March 2023| Version 1 | DOI: 10.17632/v5bdjc84gp.1
Joel Komakech


The study aimed 1) To determine the effects of a peer-led integrated nutrition education intervention on maternal social support among refugees in Uganda. 2) To analyze the relationship of the intervention using the Care Group model on IYCF practices of infants 3) To investigate the effects of a peer-led integrated nutrition education intervention using the Care Group model on infant growth among refugees in Uganda. A community-based cluster randomized controlled trial was conducted among refugee post-emergency settlements in the West Nile region in Uganda. The Adjumani district was randomly selected from among the 10 districts hosting refugees in the region. Four of 19 settlements in the Adjumani district were randomly selected and assigned to three arms of the study. Each study arm had a total of ten peer groups. Ayilo-I settlement was assigned as a Mothers-only study arm, Pagirinya and Ayilo II settlements were the Parents-combined (both Mothers and Fathers) study arm while Nyumanzi settlement was the Control arm. These settlements were at least 6 kilometers apart to reduce the possibility of spillover effects of the intervention. The intervention was conducted in the Mothers-only and Parents-combined arms. The village health team (VHT) members and health center midwife assistants supported the identification of pregnant women in their third trimester to be included in the study. Sample size The introduction of complementary foods as recommended by WHO and UNICEF was used as the primary outcome because of its reliability as an indicator of child feeding practices. The desired sample size of 317 pregnant women was calculated using GPower 3.1 software, a type I error of 0.05, a power of 0.90, and an effect size of 0.2 (14, 17) to detect differences in the proportions of infants introduced to complementary foods at 6-8 months among the 3 study arms. A 23 percent loss during follow-up was estimated; thus, 390 women (15-49 years of age) in their third trimester of pregnancy comprised the study sample and were enrolled at baseline. Husbands were eligible to participate with their wives in the Parents-combined treatment arm. Eighty-two percent (n=321) of the mother-infant dyads completed the study. The mother-infant dyads comprised the experimental unit for assessing the practices of complementary feeding of infants while infant growth was measured as an average of three indicator measures. By the end of the study, the mother-infant dyads were 119 for the Mothers-only study arm, 111 for the Parents-combined arm, and 91 for the Control arm. Baseline data was collected before the start of the intervention. Midline I, II, and Endline data was collected over the year-long study. At the end of the study, infant complementary feeding improved significantly in both Mothers-only and Parents-combined arms when compared to the Control. Also, The intervention delivered through Care Groups significantly improved infant stunting and underweight but not wasting


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The structured questionnaire used for this study was adapted from the Demographic and Health Surveys and UNHCR standardized expanded nutrition surveys (SENS) guidelines. These two questionnaires have been widely accepted for sociodemographic, health, and nutrition data collection and related information for nationally representative samples and humanitarian populations. Additional questions to assess maternal social support were adopted from the medical outcomes study (MOS) social support scale. The final questionnaire was translated into Arabic, Dinka, and Madi languages which are widely spoken by the South Sudanese in the refugee settlements in Uganda. The questionnaires were then uploaded onto electronic tablets (Lenovo Tab P11) using the Qualtrics software (Offline version). The collected data with the electronic tablets were uploaded to Qualtrics cloud storage at the end of each data collection day. Only the principal investigator and research collaborators had access to the data as part of maintaining respondent data safety. Our study used four enumerators, also called data collectors (F=3, M=1) at each data collection point throughout the study. These four enumerators with a minimum qualification of an associate degree in nutritional science, social sciences, or related fields were recruited and trained on the questionnaire. Each enumerator was proficient in English, Arabic, and one of the local languages (Madi, Nuer, or Dinka ). Each question was reviewed, and a consensus was agreed upon with the researcher on how to ask the questions and extra probing where necessary. A total of 10 households with women pregnant in their 3rd trimester were used to pretest the questionnaire in the Boroli refugee settlement. The Boroli refugee settlement where the pretesting was done was not among the settlements that were selected for the year-long study. The researcher made minor revisions and adjustments, mostly regarding the flow of questions in the Qualtrics software. Data collectors/enumerators were blinded from the study arm assignment. The collection of data/information from a single respondent was completed within 1 hour and 30 minutes. The data collection time points for this study are summarized in table III.1. At each data collection period, the participants were provided with a 1 kg bar of washing soap, 200 mL of vitamin A fortified cooking oil, and half a kilo each of iodized salt and sugar, all worth about 7,600 Ugx (1.5 USD) as compensation for participation in the study. Inclusion and exclusion criteria Mothers whose antenatal records showed pregnancy complications were excluded from the study. Mothers who gave birth to premature infants, infants with congenital abnormalities, or whose infants died had the option of remaining in the study but were excluded from the final analyses.


Oklahoma State University Stillwater