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

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