Effectiveness of a positive deviant intervention to improve appropriate feeding practices and nutritional outcomes in West Omo Zone, Maji District: South West Region, Ethiopia: A study protocol for a cluster randomized control trial

BackgroundNon-optimal infant and young child feeding practices (IYCFP) are linked to malnutrition and infant mortality in poor countries, notably in Ethiopia. The majority of growth stalls occur within the first two years of life; hence, there is a need to discover interventions that enhance appropriate IYCFP for improving nutritional outcomes during this critical period. Using the experience of mothers who have come up with solutions to their IYCFP problems to educate others is is a potential pathway to initiate and sustain behavioral changes in resource-limited areas. However, such interventions are not widely implemented in Ethiopia. ObjectiveThis study aims to assess the effectiveness of a positive deviant (hearth nutrition education) intervention to improve appropriate feeding practices and nutritional outcomes in West Omo Zone, Maji District: South West region, Ethiopia. MethodsA cluster randomized controlled trial will be conducted to compare the effect of positive deviant intervention versus routine health educationa. The intervention will be provided by positive deviant mothers who are members of the community using WHO infant and young child feeding guidelines, and "training of the trainers manual on counseling and supporting non-positive deviant mothers, infant and young child feeding" in the local language. Culturally appropriate and scientifically acceptable operational packages of information will be developed. Using preset criteria, 516 mothers will be recruited from 36 zones. The intervention arm will receive 12 demonstration (hearth) session in groups and every 15th day home visit by positive deviant mothers. Data will be entered into epi-data version 3.1 and analyzed using STATA version 13.0. All analyses will be done as intention-to-treat. We will fit mixed effects linear regression models for the continuous outcomes and mixed effects linear probability models for the binary outcomes with the study zone as random intercept to estimate study arm difference (intervention vs. routine health education) adjusted for baseline value of the outcome and additional relevant covariates. The protocol was developed in collaboration with the West Omo Zone and Maji Woreda Health Office. Ethical approval (Ref no: IHRPG/938/2020) was obtained from Jimma University, Institute of Health Research and Postgraduate Office. This study is funded by Jimma University research and postgraduate office. DiscussionWe expect that the trial will generate findings informing IYCFP and nutritional policies and practices in Ethiopia. Trial registrationRegistry: PACTR202108880303760 (30/08/2021); www.pactr.org, URL : https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=16081