The effect of care groups on infant and young child feeding, dietary diversity and WASH behaviours in rural Zimbabwe: A case-control study

BackgroundThe care group model is a sustainable low cost community-based strategy to achieve nutrition related behaviour change and improve nutrition and diet quality indicators. ObjectiveTo evaluate the effect of the care groups on achieving positive infant and young child feeding, dietary diversity and WASH behaviours. MethodsA case-control study utilised a mixed method approach targeting seven rural districts in Zimbabwe in June 2022. A structured questionnaire was used to collect data on IYCF, diet quality, WASH, and child morbidity. Binary logistic regression was used to evaluate the association between exposure (intervention) and outcome. Significance was at P<0.05. ResultsA total of 127 cases and 234 controls were enrolled. There was no significant difference between cases and controls on the prevalence of; diarrhoea (P=0.659), cough (P=0.191), and fever (P=0.916). No significant difference was observed in the proportion ever breastfed (P=0.609), diet quality-children with adequate dietary diversity score (CDDS) (P=0.606) across the two groups. However, the proportion of families with adequate Household Dietary Diversity Score (HDDS) (P=0.005) and minimum dietary diversity for women (MDD-W) (P=0.009) were significantly higher in cases than controls. Furthermore, the knowledge and practice of all promoted behaviours were significantly higher in the cases than in controls with exception of exclusive breastfeeding. Practice was significantly higher in cases compared to controls for: "Appropriate complementary feeding for children aged 6-24months" (P=0.001), "good nutrition for women of childbearing age" (P=0.001), "production and consumption of diverse nutritious food" (P=0.001) and "production and consumption of biofortified crops" (P=0.001). ConclusionsThe current results adds to the body of evidence showing that care groups are effective for achieving sustainable nutrition and WASH related behaviour change in a low-income setting. Overall, care groups should be implemented to scale coverage" and integrated into existing community nutrition programs for maximum impact. Key MessagesO_LIThe current results add onto the limited evidence showing the potential of care group approach towards improved IYCF, dietary diversity, WASH behaviours and practices in low-income settings. However, this approach should be implemented to scale and not in isolated pockets of the community to ensure positive impact on nutrition indicators. C_LIO_LIThe care group SBCC strategy led to improved knowledge and selected practices. However, there was no significant impact on child morbidity indicators and child diet quality indicators. C_LIO_LIThe care group approach should be integrated into community-based nutrition programming guided by the key lessons learned from pilot districts. C_LIO_LIEmphasis should be on how improved knowledge and practices can translate to improved child IYCF indicators. C_LI