CRITICAL ASSESSMENT OF THE IMPACT PATHWAYS OF COMMUNITY-BASED INTERVENTIONS ON CHILD FEEDING AND HYGIENE BEHAVIORS IN RURAL ZIMBABWE

CRITICAL ASSESSMENT OF THE IMPACT PATHWAYS OF COMMUNITY-BASED INTERVENTIONS ON CHILD FEEDING AND HYGIENE BEHAVIORS IN RURAL ZIMBABWE Dadirai Fundira, Ph.D Cornell University 2019 Undernutrition remains prevalent in low- and middle-income countries and is an important indirect cause of childhood morbidity and mortality. Poor dietary intake and infection have been identified as the immediate causes of undernutrition in children. Evidence for efficacious interventions to improve dietary intake has been developed but their impact depends on the context in which they are implemented. Although ingestion of fecal microbes has been linked with infection, interventions to address this in children are limited and the available interventions do not address important pathways for fecal-oral contamination in children. This dissertation comprises of three studies with an overall aim of assessing the impact of complementary feeding (CF) and water sanitation hygiene (WASH) interventions on maternal caregiving behaviors in rural Zimbabwe. A CF feeding intervention that used behavior-change communication (BCC) to promote timely and adequate complementary feeding and provided a small-quantity, lipid-nutrient supplement (SQLNS) was evaluated using in-depth, multi-pass assessment of nutrient intake. We found that the CF intervention improved macro- and -micronutrient intake and increased the prevalence of children who consumed an adequate diet. We used rigorous baby-observation methods to evaluate the impact of a comprehensive WASH intervention targeting fecal-oral contamination pathways in children less than 24 months old on key hygiene behaviors. We found that the WASH interventions reduced but did not eliminate exposure to vectors of fecal-oral microbial transmission in children. We also investigated the emic perspectives on women’s experiences with the different interventions and used ethnographic methods to identify facilitators and barriers to intervention uptake. This exploration revealed that caregiving decisions and intervention uptake are influenced by multiple factors. These factors included aspects of the caregiving environment, maternal capabilities, the intervention messages, and the person who delivered the intervention. Our results suggested that the perceived benefits of interventions on child health were the most important factor that drove women’s caregiving decisions. This dissertation used in-depth methods to evaluate child care interventions and provide comprehensive information on if, what, how and why interventions worked in the context of rural Zimbabwe. The results of this research show interventions that can be adapted and scaled up to improve caregiving behaviors around infant feeding and hygiene in rural communities