Impact of Behaviour Change Communication Intervention on Responsive Feeding Practices of Caregivers of Infants and Young Children, 6-23 months in Ghana

Impact of Behaviour Change Communication Intervention on Responsive Feeding Practices of Caregivers of Infants and Young Children, 6-23 months in Ghana | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Behaviour Change Communication Intervention on Responsive Feeding Practices of Caregivers of Infants and Young Children, 6-23 months in Ghana Akosua Achiaa Akosah, Linda Nana Esi Aduku, Godwin Opoku Agyemang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7541937/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Optimal infant and young child feeding is critical to healthy growth and cognitive development during the first two years of life. The World Health Organization’s Complementary Feeding (CF) guidelines emphasize not only what to feed but also how , with Responsive Feeding (RF) being a key psychosocial component that encourages sensitive, non-coercive interactions that respond to children's hunger and satiety cues. This study examined the factors associated with RF and Feeding During Illness and Recovery (FDIR) practices, and evaluated the effect of a Nutrition Behaviour Change Communication (NBCC) intervention, aligned with WHO CF guidelines, on these practices among caregivers of children aged 6–23 months in the Bosomtwe District of Ghana. Method A total of 525 mother-infant pairs were recruited at baseline: 322 (61.3%) received the NBCC intervention while 203 (38.7%) served as controls. The six-month intervention included structured education, personalized counselling, and practical demonstrations on appropriate CF and RF. Data on RF and FDIR practices were collected pre- and post-intervention and analysed using Mann-Whitney U tests, paired t-tests, and logistic regression. At baseline, only 6.3% of caregivers demonstrated good RF practices, and a mere 3.0% practiced appropriate FDIR. Results No significant associations were observed between caregivers' socio-demographic characteristics and feeding practices. Importantly, caregivers with poor RF had markedly lower odds of practicing good FDIR (OR = 0.03, p < 0.001). Pre-intervention RF practices were similarly poor across intervention (94.4%) and control groups (92.6%, p = 0.408). However, post-intervention, the proportion of caregivers practicing poor RF reduced by over 50% in the NBCC group (to 40.2%) compared to only a marginal reduction in controls (86.8%, p < 0.001). Improvements in FDIR mirrored these trends. Post-intervention, NBCC participation was strongly associated with reduced odds of poor RF (OR = 0.1, 95% CI p < 0.001 ), a reversal from baseline trends. Conclusion These findings underscore the transformative potential of well-designed, context-sensitive behaviour change communication grounded in global best practices. Scaling up NBCC interventions aligned with WHO guidelines can substantially improve caregiver feeding behaviours, particularly in low-resource settings, thereby enhancing child health outcomes during this critical developmental window. behaviour change communication responsive feeding caregivers infants and young children complementary feeding child nutrition Ghana Background A mother or caregiver’s perspective and caregiving behaviours play a pivotal role in shaping a child’s nutritional status and overall health, particularly during the critical window of the first 1,000 days of life [ 1 , 2 , 3 ]. Among children under 24 months, stunting and other forms of undernutrition are influenced not only by dietary intake and disease exposure but also by how feeding is practiced [ 4 , 5 ]. Increasingly, feeding behaviours—especially the quality of caregiver-child interaction during feeding—are being recognized as a vital determinant of survival, growth, and development [ 6 ]. Responsive Feeding (RF) , as defined by the World Health Organization (WHO) and UNICEF, is a cornerstone of recommended Infant and Young Child Feeding (IYCF) practices [ 7 ]. It is embedded within the broader framework of psychosocial care and includes practices such as recognizing and responding to a child’s hunger and satiety cues, avoiding force-feeding, providing encouragement without coercion, and creating a positive feeding environment [ 1 , 8 ]. Responsive feeding is particularly important during the transition from exclusive breastfeeding to complementary feeding, as children begin to establish lifelong eating patterns and food preferences. Despite its proven importance, the implementation of responsive feeding remains a challenge in many low- and middle-income countries (LMICs), including Ghana [ 9 ]. Caregivers often lack awareness or understanding of RF principles, and socio-cultural norms, time constraints, food insecurity, and limited support systems can hinder their practice [ 10 , 11 ]. Studies across various LMIC settings have reported that RF practices are suboptimal and poorly understood [ 12 , 13 ]. For example, a study in Ethiopia found that only 17% of caregivers demonstrated adequate responsive feeding behaviours, with maternal education and access to counselling services emerging as strong predictors of good practice [ 14 ]. Similarly, research in Bangladesh linked responsive feeding to better dietary diversity and improved growth outcomes, and emphasized the role of maternal knowledge, autonomy, and emotional well-being [ 15 ]. Behaviour Change Communication (BCC) strategies have emerged as key tools in promoting optimal IYCF practices, including RF [ 16 ]. BCC interventions aim to influence individual and community behaviours through targeted communication methods such as counselling, demonstrations, mass media, and peer support [ 17 ]. When appropriately designed and delivered, BCC interventions can be highly cost-effective and impactful in improving maternal knowledge and practices related to child nutrition [ 18 ]. Nevertheless, while the utility of BCC is widely acknowledged, evidence on its specific contribution to enhancing responsive feeding remains limited. Much of the existing literature focuses on dietary intake or breastfeeding, with fewer studies examining the nuanced behavioural and psychosocial aspects of feeding interactions [ 2 , 16 , 19 , 20 ]. Building on global recommendations and emerging evidence of the effectiveness of BCC in improving child nutrition, this study assessed the impact of a structured BCC intervention—grounded in WHO complementary feeding guidelines—on the responsive feeding and Feeding During Illness and Recovery (FDIR) practices of caregivers of children aged 6–23 months in the Bosomtwe District of Ghana. By focusing on how caregivers engage with their children during feeding, this study contributes to the growing body of knowledge on how communication-based interventions can influence not just what children eat, but how they are fed—an equally critical component of child nutrition and well-being. Materials and Methods Study design and setting The study design is a community-based non-randomised controlled trial which was carried out in the Bosomtwe district of the Ashanti region of Ghana. The Bosomtwe District is one of the twenty-seven (27) districts that make up Ghana's Ashanti Region. A mixed method approach including structured questionnaires, interviews with mothers, and BCC were used for data collection at baseline and six months post-intervention. Eleven Child Warefare Clinics (CWCs) were purposively selected for the study. All eleven CWCs were eligible for a World Food Programme (WFP)/ Ghana Health Service (GHS) collaborative BCC intervention. However, to enable this study, 5 CWCs had to serve as controls while the first group of six CWCs were allocated to the BCC intervention. After the post-intervention survey, the other five CWCs were provided the intervention. Study sample and selection process The study included mothers and their children between the ages of 6 to 17 months at baseline and six months post intervention. The children were 6–17 months at baseline and so post intervention, the minimum age was 12 months and maximum age was 23 months. In each CWC, mothers-children pairs within the required age in the CWC registers were eligible for recruitment. Announcements were made for caregivers/mothers to visit the CWC on some chosen dates. Study enumerators recruited caregivers/mothers who turned up on these chosen dates. Mothers who were unwilling to participate, had a child younger than 6 months or older than 17 months for the baseline study, or had not begun complementary feeding even though their children six months or above were also excluded. 525 mother-infant pairs were recruited for the baseline survey. At post-intervention, 391 respondents were available to participate in the assessment, giving a follow-up rate of 74.5%. When grouped into intervention and control, 322 mother-child were in the intervention group and 203 of the controls were recruited at baseline while 247 (76.7%) intervention and 145 (71.4%) controls completed the follow study. Data collection tools Data were collected digitally using tablets and an electronic format of questionnaires on Surveybe app tool. A structured questionnaire was developed by the study team specifically for this study to capture caregiver and child sociodemographic information, feeding practices, exposure to the behaviour change communication (BCC) intervention, and responsive-feeding behaviours. The questionnaire is provided as Supplementary File 1. In-person interviews were done with mothers and children aged 6 to 17 months who were present at the CWCs. Recruitment and training of field staff Ten (10) enumerators, four nutritionists, and two lab technicians were recruited for the survey. The supervisors spent two days training the enumerators to understand the questionnaires and conduct the interviews using the Surveybe app tool installed on an Android Huawei tablet. At the end of each day, the supervisors double-checked all questionnaires to ensure consistency and completeness. Baseline study The Baseline Household Survey was conducted in August, 2020. This was conducted on responsive feeding practices, and complementary feeding practices of the mother-child pairs in both intervention and control CWCs. Baseline assessment of responsive feeding practices A 5-item questionnaire was used to determine responsive feeding practices among mothers. The scale asked twenty-one (21) Yes/No questions about responsive feeding practices. The variables "fed slowly and patiently," "fed child's favourite food," "breastfed on demand," "stopped feeding," "force-fed child," and "punished child" were measured as ways among the several elements of responsive feeding practices that mothers or primary caregivers use when introducing their children to new food and when their children lost appetite. Among the several elements of responsive feeding mother or primary caregiver use when the child refuses to eat a meal, the variables "gave alternative/changed food", "breastfed, gave solid food, breastfed again", "talked to child", "sang to child", "force-fed child", "stopped feeding" and "punished child" were measured. A multiple-response questionnaire required the enumerator to mark all of the feeding practices indicated by the mother or primary caregiver. Mothers or primary caregivers were asked to respond to practices associated with each feeding style by data collectors. However, because many mothers or primary caregivers used more than one feeding style, they were classified into three responsive feeding practices (good, moderate, or low) based on their overall responsive feeding score. In addition to the overall responsive feeding score, good practices (10 Yes/No questions were graded 1 for Yes and 0 for No) and bad practices (11 Yes/No questions were graded 1 for No and 0 for Yes) were evaluated. As a result, mothers or primary caregivers who practiced a specific style the majority of the time for responsive feeding items were scored with 15 to 21, 8 to 14, and 0 to 7, respectively, and were considered to have good, moderate, or low responsive feeding practices depending on the response to each item. The questions were chosen in accordance with WHO’s guiding principles for complementary feeding as taught in the various CWCs. Questions were translated and back-translated, and they were piloted to make sure that they were easily understood, and those open-ended questions triggered appropriate responses. BCC Intervention Health care workers (HCWs) in the six CWCs allocated the intervention were trained to provide BCC on IYCF practices. The BCC training was held for 3 days and provided by resource persons from the Ghana Health Service. The BCC training involved breastfeeding initiation, exclusive breastfeeding and appropriate complementary feeding recommendations. Following the training, HCW used the knowledge, understanding and skills they had obtained to counsel mothers and caregivers in the six intervention CWCs. The HCWs provided monthly counselling when mothers and caregivers attended CWC sessions and answered questions and clarifications of the mothers/caregivers. In addition, the trained enumerators at baseline also counselled mothers/caregivers on IYCF guidelines. HCWs working in the five control CWCs did not receive the BCC training for this first six months. The study enumerators did not provide and reinforcement messages to mothers/caregivers from the CWCs that served as controls. Follow-up phone calls were made in November, 2020 to the intervention caregivers/mothers. The aims of the calls were to verify the compliance of the information received, address any questions caregivers or mothers may have, and reinforce the BCC messages. An interventions compliance questionnaire scale of 1 to 10 (1 being the minimum and 10 being the maximum) were asked to ascertain the levels of compliance of respondents. Post intervention assessment Caregivers/mothers were surveyed after 6 months post intervention. All the baseline data collected were repeated. Data Analysis The research data collected in the field was processed and analyzed through a series of stages. They were screened, sorted, cross-checked and verified to ensure that there were no errors or missing values in the data entry. Data entry, management, and analysis were carried out using Statistical Product for Service Solution (SPSS) version 26 and R statistical software for descriptive statistics. A Pearson’s chi-square test, cross-tabulation was used to compare the frequencies of socio-demographic characteristics, maternal perception of child's nutritional status, maternal hygiene practices, and start of complementary feeding, maternal knowledge and practices of using Protein Micronutrient powder (PMP), child's symptoms, hunger, and poverty status by intervention group, responsive feeding practices, and feeding during illness and recovery. Crude models, Mann-Whitney U tests and paired sample T-tests were also used to calculate the significance of the dependent variable and various independent variables of interest. Linear regression analysis was also used at the 5% significance level to investigate factors related to responsive feeding practices among the sampled mothers, and the impact of nutrition education on responsive feeding practices among the sample children. To compare the various independent and dependent variables, standard deviations and means were also used. Tables were used to present the findings. Results Demographic Characteristics of Mothers and Children The majority of mothers in both the intervention and non-intervention groups were aged 18 years and above—97.2% and 98.5%, respectively—with a mean age of 29 years (range: 16–47). Slightly more teenage mothers were present in the intervention group (2.8%) than in the control group (1.5%). Unemployment was higher among non-intervention mothers (34.5%) than among those in the intervention group (26.4%). Additionally, a significantly higher proportion of intervention mothers (45.6%) experienced moderate-to-high lived poverty compared to non-intervention mothers (41.9%) (p = 0.013). Other socio-demographic variables, such as education level and household hunger status, showed no significant differences between the groups. Among the children, male representation was higher in both groups (63.6% in the intervention group and 59.2% in the control group). The age distribution was also similar between groups, with most children falling within the 12–17 months age range and a mean age of 11.4 months. [Insert Table 1 here] Table 1 Socio demographic characteristics of mothers and children among the two intervention groups Characteristic Total (n) Intervention n(%) Non-intervention n(%) X-Squared (P-value) Gender of children 1.1(0.296) Male 253 161(63.6) 92(36.4) Female 272 161(59.2) 111(40.8) Age Group 0.2(0.691) 6 to 11 months 271 164(60.5) 107(39.5) 12 to 17 months 254 158(62.2) 96(37.8) Mean age in months 11.4 ± 3.3 Range 6–17 Age of Mothers 1.0(0.325) < 18 12 9(2.8) 3(1.5) ≥ 18 513 313(97.2) 200(98.5) Mean age in years 29.3 ± 6.5 Range 16–47 Education 3.4(0.066) Up To Basic 87 61(18.9) 26(12.8) Above Basic 438 261(81.1) 177(87.2) Occupation 3.9 (0.048) Employed 370 237(73.6) 133(65.5) Unemployed 155 85(26.4) 70(34.5) LPI 8.8(0.013)* Low 293 175(54.3) 118(58.1) Moderate 105 77(23.9) 28(13.8) High 127 70(21.7) 57(28.1) HHS 5.3(0.071) No hunger 253 167(51.9) 86(42.4) Moderate Hunger 101 61(18.9) 40(19.7) Severe Hunger 171 94(29.2) 77(37.9) Data are reported as frequency (percentage), Chi square (X 2 ), P-values are reported, P-value is significant at p < 0.05 Responsive Feeding Practices at Baseline and Post-Intervention At baseline, the vast majority of mothers (93.7%) exhibited poor responsive feeding practices. Only 6.3% had good practices. Six months after the intervention, the proportion of mothers with good feeding practices increased significantly to 41.7%, while those with poor practices decreased to 58.3% (p < 0.001). In terms of severity, 58.5% of mothers had moderate responsive feeding practices and 35.2% had low levels at baseline. By post-intervention, moderate feeding practices had declined to 43%, and low levels dropped markedly to 15.3%, indicating a significant overall improvement in responsive feeding behaviors (p < 0.001). [Insert Table 2 here] Table 2 Assessment of responsive feeding practice among mothers at baseline and post intervention RFP categories Baseline n (%) Endline n (%) Chi-Square (X 2 ) P-value RFP severity 174.8 < 0.001* Good 33(6.3) 163(41.7) Moderate 307(58.5) 168(43.0) Low 185(35.2) 60(15.3) RFP status 167.0 < 0.001* Good 33(6.3) 163(41.7) Bad 492(93.7) 228(58.3) Total 525(100) 391(100) The data were represented in proportions, with the percentage in parenthesis. The Pearson Chi-Square (X 2 ) tests were used to compare the proportions. (*) represents significant statistical association at p˃0.05 (Categories low = 0–7, moderate = 8–14, good = 15–21, Bad = 0–14) Socio-Demographic Characteristics and Feeding Practices At baseline, all mothers under 18 years of age (100%) practiced poor responsive feeding, compared with 93.6% among those aged 18 years and older, a statistically significant difference (p = 0.036). By the end of the intervention, poor feeding practices had declined to 45.5% among teenage mothers and to 58.7% among older mothers. Education level did not significantly influence feeding practices at either baseline or endline. At baseline, 92.0% of mothers with basic education and 94.1% with education above basic practiced poor feeding. At endline, poor practices were reported in 51.5% of mothers with basic education and 59.7% of those with higher education. Employment status was also not significantly associated with responsive feeding. At baseline, poor practices were reported by 93.5% of employed mothers and 94.2% of unemployed ones. After the intervention, poor feeding practices reduced to 56.5% among employed mothers and to 63.2% among unemployed ones. [Insert Table 3 here] Table 3 Association of maternal socio-demographic features and responsive feeding practices at baseline and post interventionpost-intervention Baseline Endline Variables Total n (%) Responsive Feeding Practice X 2 (P-value) Total n (%) Responsive Feeding Practice X 2 (P-value) Bad n (%) Good n (%) Bad n (%) Good n (%) Mothers Age Group 0.8(0.364) 0.8(0.380) < 18 12 12(100) 0(0.0) 11 5(45.5) 6(54.5) \(\:\ge\:\) 18 513 480(93.6) 33(6.4) 380 223(58.7) 157(41.3) Overall 525 492(93.7) 33 (6.3) 391 228(58.3) 163(41.7) Education 0.5(0.459) 1.5(0.219) Up to Basic 87 80(92.0) 7(8.0) 66 34(51.5) 32(48.5) Above Basic 438 412(94.1) 26(5.9) 322 194(59.7) 131(40.3) Employment 0.1(0.770) 1.4 (0.231) Employed 370 346(93.5) 24(6.5) 285 161(56.5) 124(43.5) Unemployed 155 146(94.2) 9(5.8) 106 67(63.2) 39(36.8) The data were represented in proportions, with the percentage in parenthesis. The Pearson Chi-Square (X 2 ) tests were used to compare the proportions. (*) represents significant statistical association at p˃0.05 (Categories bad = 0–14, good = 15–21) Other Determinants of Feeding Practices At baseline, the only significant factor associated with responsive feeding was feeding during illness and recovery. Mothers who practiced appropriate feeding during these periods were significantly more likely to exhibit good feeding practices (p < 0.001). No significant associations were found between feeding practices and maternal perception of child’s nutritional status, child’s symptoms, age at complementary feeding initiation, purchasing of commercial fortified foods, handwashing behaviors, knowledge or use of PMP, or household poverty or hunger status. By post-intervention, several new associations emerged. Mothers’ perception of their child’s nutritional status was significantly linked to responsive feeding (p = 0.033). Mothers who believed their child was healthy were more likely to practice good feeding. Child symptoms were also significantly associated with feeding practices (p < 0.001), with mothers of symptomatic children showing poorer practices. Hand washing before feeding (p < 0.001) and before meal preparation (p < 0.001) were both strongly associated with better responsive feeding practices. Additionally, mothers who had knowledge of PMP (p = 0.012) and those who practiced its use (p < 0.001) were significantly more likely to feed responsively. However, no significant associations were observed between post-intervention feeding practices and complementary feeding start time, purchase of commercial fortified foods, household hunger, or poverty status. [Insert Table 4 here] Table 4 Relationship between other factors and responsive feeding practices at baseline and post intervention Baseline Endline Variables Total n (%) Responsive Feeding Practice X 2 (P-value) Total n (%) Responsive Feeding Practice X 2 (P-value) Bad n (%) Good n (%) Bad n (%) Good n (%) Mother’s Perception 1.0 (0.310) 4.5 (0.033)* Good 432 407(94.2) 25(5.8) 355 201(56.6) 154(43.4) Bad 93 85(91.4) 8(8.6) 36 27(75.0) 9(25.0) Child symptoms 1.3 (0.263) 68.6 (< 0.001)* At least one 349 330(94.6) 19(5.4) 207 161(77.8) 46(22.2) None 176 162(92.0) 14(8.0) 184 67(36.4) 117(63.6) FDIRs 88.5 (< 0.001)* 0.1 (0.738) Bad 509 486(95.5) 23(4.5) 265 153(57.7) 112(42.3) Good 16 6(37.5) 10(62.5) 126 75(59.5) 51(40.5) LPI 0.6(0.756) 0.7(0.704) Low 293 273(92.2) 20(6.8) 208 125(60.1) 83(39.9) Moderate 105 100(95.2) 5(4.8) 82 45(54.9) 37(45.1) High 127 119(93.7) 8(6.3) 101 58(57.4) 43(42.6) HHS 1.2 (0.925) 1.9 (0.380) No Hunger 253 236(93.3) 17(6.7) 188 104(55.3) 84(44.7) Moderate Hunger 101 95(94.1) 6(5.9) 78 45(57.7) 33(42.3) Severe Hunger 171 161(94.2) 10(5.8) 125 79(63.2) 46(36.8) Hand wash before feeding 0.9 (0.356) 34.1 (< 0.001)* Yes, all the time 386 364(94.3) 22(5.7) 309 157(50.8) 152(49.2) No 139 128(92.1) 11(7.9) 82 71(86.6) 11(13.4) Hand wash before preparing meal 0.4 (0.533) 25.1 ( 6months 171 162(94.7) 9(5.3) 133 80(60.2) 53(39.8) ≥ 6months 354 330(93.2) 24(6.8) 258 148(57.4) 110(42.6) Overall purchase CFF 0.2 (0.645) 1.1 (0.293) None 43 41(95.3) 2(4.7) 23 11(47.8) 12(52.2) At least one 482 451(93.6) 31(6.4) 368 217(59.0) 151(41.0) Knowledge of PMP 0.4 (0.515) 6.3 (0.012)* Yes 226 210(92.9) 16(7.1) 343 192(56.0) 151(44.0) No 299 282(94.3) 17(5.7) 48 36(75.0) 12(25.0) Practice using PMP 0.02 (0.896) 53.2 (< 0.001)* Yes 100 94(94.0) 6(6.0) 210 87(41.2) 123(58.6) No 425 398(93.6) 27(6.4) 323 141(77.9) 40(22.1) The data were represented in proportions, with the percentage in parenthesis. The chi square (X 2 ) test was used to compare the proportions. (*) represents significant statistical association at p˃0.05 (Categories bad = 0–14, good = 15–21) 3.5. Effect of Social and Behavior Change Communication (SBCC) At baseline, there was no statistically significant difference in responsive feeding practices between mothers in the intervention and control groups. Poor practices were observed in 94.4% of the intervention group and 92.6% of the control group (p = 0.408). After six months of SBCC intervention, poor feeding practices decreased substantially in the intervention group to 40.2%, while they remained high at 86.8% in the control group. This difference was statistically significant (p < 0.001). [Insert Table 5 here] Table 5 Impact of SBCC on responsive feeding practices at baseline and post intervention Variables Baseline X 2 (p-value) Post intervention Received SBCC X 2 (p-value) Responsive feeding practice Intervention group n(%) Control n(%) 0.7 (0.408) Intervention group n(%) Control n(%) 83.3 (< 0.001)* Bad 304 (94.4) 188 (92.6) 96 (40.2) 132 (86.8) Good 18 (5.6) 15 (7.4) 143 (59.8) 20 (13.2) Total 322 (100) 203 (100) 239 (100) 152(100) Frequency (percentage) are reported, chi-square(X 2 ) values are reported, and p-values are significant at p < 0.05 Logistic regression analysis confirmed the positive impact of the intervention. At baseline, SBCC exposure did not significantly influence feeding behavior (OR = 0.7; p = 0.410; 95% CI = 0.4–1.5). However, after the intervention, mothers who received SBCC were nearly 10 times more likely to practice good responsive feeding (OR = 9.8; p < 0.001; 95% CI = 5.7–16.8). [Insert Table 6 here] Table 6 Logistic regression analysis of impact of SBCC on responsive feeding practices among mothers at baseline and post intervention Variables Good responsive feeding practice Baseline Post Intervention OR 95% CI p-value OR 95% CI p-value SBCC Intervention 0.7 0.4–1.5 0.410 9.8 5.7–16.8 < 0.001* Control 1.0 1.0 Differences in Mean Feeding Scores Paired sample t-test analysis showed significant improvements in mean responsive feeding practice scores in both groups. Among the intervention group, the mean score increased from 6.87 to 15.32, with a mean difference of + 8.45 (p < 0.001). In the non-intervention group, scores increased from 6.84 to 8.40, with a smaller but still significant mean difference of + 1.53 (p < 0.001). These results further reinforce the effectiveness of the SBCC intervention. [Insert Table 7 here] Table 7 Mean comparisons and paired sample T-test analysis of responsive feeding practices between the two intervention groups at both baseline and Endline Intervention Time N mean SD MD p-value Intervention Baseline 247 6.87 ± 2.50 8.45 < 0.001* Endline 247 15.32 ± 3.13 Non-intervention Baseline 144 6.84 1.89 1.53 < 0.001* Endline 144 8.40 2.37 Discussion This study involved 525 mother–child pairs. The mean age of participating mothers was 29 years, with a range from 16 to 47 years. These findings are consistent with those of Lazarus et al., whose study in South Africa included mothers of similar age [ 21 ]. Regarding educational attainment, 18.9% of mothers in the intervention group had only basic education, while 81.1% had progressed beyond basic level. Among non-intervention mothers, 12.8% had only basic education, and 87.2% had continued their education. The mean age of children in this study was 11.4 months, which aligns closely with findings from Redsell, who investigated factors influencing caregivers' responsive feeding behavior [ 22 ]. The majority of children in the intervention group (62.2%) were aged 12 to 17 months, while 60.5% were aged 6 to 11 months. Male children were more represented in the intervention group (63.6%) compared to the control group (36.4%). At baseline, 35.2% of mothers practiced low-level responsive feeding, and 58.5% practiced moderate-level responsive feeding. After six months of intervention, these figures dropped significantly to 15.3% and 43%, respectively. Overall, 93.7% of mothers exhibited poor responsive feeding practices at baseline, which improved significantly to 58.3% after the intervention. Consistent with Kalra et al., this study identified maternal characteristics—such as age, education, and employment—as important factors influencing responsive feeding practices [ 23 ]. At baseline, 5.9% of mothers with education beyond basic level and 8% of those with only basic education practiced good responsive feeding. Post-intervention, 40.3% of mothers with higher education and 48.5% of those with basic education practiced good feeding. Employment also played a role: at baseline, 6.5% of employed mothers and 5.8% of unemployed mothers practiced good feeding. After the intervention, these figures increased to 43.5% and 36.8%, respectively. At baseline, 5.8% of mothers with a positive perception of their child’s nutritional status practiced good feeding. Among children with at least one symptom of illness, 5.4% were fed responsively. Additionally, 62.5% of mothers who practiced appropriate feeding during illness and recovery demonstrated good feeding behavior. However, differences in feeding practices based on household poverty or hunger levels were not statistically significant. After the intervention, several factors were significantly associated with improved feeding. Among mothers who had a positive perception of their child's nutritional status, 43.4% practiced good feeding. Similarly, 22.2% of mothers with symptomatic children, 49.2% of mothers who consistently washed their hands before feeding, and 48.8% who consistently washed hands before meal preparation practiced good feeding. Additionally, 44% of mothers with knowledge of the use of a fortified food supplement (PMP) and 58.6% who actually used it demonstrated good responsive feeding practices. These results echo the findings of studies, who reported that income and nutritional knowledge influence maternal readiness to adopt responsive feeding [ 23 , 24 ]. Redsell et al. similarly noted that childhood illnesses such as fever, vomiting, and diarrhea can trigger increased feeding responsiveness from caregivers, who interpret crying or signs of discomfort as hunger cues. In that study, 65% of mothers whose children were ill reported feeding them even without clear signs of hunger [ 22 ]. At baseline, mothers who failed to feed their children appropriately during illness and recovery were significantly less likely to practice good feeding (OR = 0.03). Post-intervention, mothers with negative perceptions of their child’s nutritional status had lower odds (OR = 0.4) of practicing good feeding, and those whose children experienced illness had similarly reduced odds. Mothers who did not wash hands before feeding and meal preparation had odds of 0.2 and 0.3, respectively, for practicing good feeding. Similarly, those with no knowledge or use of the PMP supplement had 0.4 and 0.2 lower odds of good responsive feeding, respectively. Importantly, the intervention—particularly the social behavior change communication (SBCC) component—was effective in promoting improved child feeding practices [ 17 ]. The six-month SBCC intervention led to a shift from poor to good practices across multiple indicators, suggesting that the promoted behaviors were acceptable and culturally compatible despite initial low adherence. The study found that SBCC had a strong positive impact on responsive feeding practices among mothers in the intervention group. Although the control group also showed a slight positive change, it is possible that mothers in both groups interacted in the same communities, leading to some cross-sharing of information. This potential contamination may partially explain the slight improvement in the control group. These findings are consistent with Kim et al., who demonstrated that implementing SBCC strategies across multiple platforms is both feasible and effective, resulting in improved responsive feeding behaviors over a two-year period [ 25 ]. Limitations of the Study This study was limited to mothers with children aged 6 to 23 months residing in the Bosomtwe District. Therefore, the findings may not be generalizable to other districts within the Ashanti Region or across Ghana. Additionally, due to the mobile nature of the population, some mothers who participated at baseline were unavailable for follow-up or dropped out before completing the intervention. This attrition led to a reduced sample size at the end of the study. Conclusion This study demonstrated that behavior change communication (BCC) based on WHO guidelines for appropriate complementary feeding significantly improved responsive feeding practices and feeding during illness and recovery among mothers of young children in the Ashanti Region, Ghana. The findings underscore the potential of BCC to improve maternal feeding practices, contributing to better child nutrition outcomes. Furthermore, the results highlight the importance of monitoring and evaluating behavior change interventions to fully understand their impact at the district level, inform program design, and scale up best practices in maternal and child nutrition. Abbreviations BCC : Behaviour Change Communication CF : Complementary Feeding FDIR : Feeding During Illness and Recovery GHS : Ghana Health Service HCW : Health care worker HHS : Household Hunger Scale IYCF : Infant and Young Child Feeding LMICs : Low- and middle-income countries LPI : Lived Poverty Index NBCC : Nutrition Behaviour Change Communication PMP : Protein Micronutrient powder RF : Responsive Feeding SBCC : Social Behaviour Change Communication (BCC) UNICEF : United Nations Children's Fund WHO : World Health Organization WFP : World Food Programme Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. A general ethical approval letter and consent form was obtained from both the Committee on Human Research Publication and Ethics (CHRPE), the School of Medical Science, Kwame Nkrumah University of Science and Technology, and the District Health Director (Approval no: CHRPE/AP/231/20). Trained enumerators explained the purpose of the study to the participants in the health center. Written and signed informed consent was obtained from all participants following the CHRPE protocol prior to the study Consent for Publication Not applicable Availability of Data and Materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding The authors received no external funding and self-funded all research costs for this study. Authors' contributions RAA, CA, SO, and TS made substantial contributions to the conception, design, and implementation of the study. AAA, LNEA, and GOA did data collection and data analysis. RAA and AAA made substantial contributions to data analysis and the draft of the manuscript. All authors read and approved the final draft of the manuscript for publication. Acknowledgements We wish to acknowledge the health director and the community nutritionist in the Bosomtwe district for supporting the implementation of the research. Also, we appreciate all the enumerators, healthcare workers, and nurses at the various CWCs for their immense support in collecting the data for the study. To all the caregivers and children who participated in the study, we are very grateful to you for your time and patience. Thank you all. References Engle PL, Menon P, Haddad L. Care and nutrition: concepts and measurement. World Dev. 1999;27(8):1309–37. Engle PL, Bentley M, Pelto G. The role of care in nutrition programmes: current research and a research agenda. Proc Nutr Soc. 2000;59(1):25–35. Rogers E, Bell L, Mehta K. Exploring the role of grandparents in the feeding of grandchildren aged 1–5 years. J Nutr Educ Behav. 2019;51(3):300–6. Mahgoub SE, Nnyepi M, Bandeke T. Factors affecting prevalence of malnutrition among children under three years of age in Botswana. Afr J Food Agric Nutr Dev. 2006;6(1):1–15. Maradzika J, Makwara IP, Chipunza S. Factors associated with stunting among children aged 0 to 59 months in Harare city, Zimbabwe. Int J Child Health Nutr. 2016;5(1):31–44. Engle PL, Pelto GH. Responsive feeding: implications for policy and program implementation. J Nutr. 2011;141(3):508–11. doi:10.3945/jn.110.130039. World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: WHO; 2018. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. doi:10.1016/S0140-6736(13)60937-X. Fanzo J, Hawkes C, Udomkesmalee E, Afshin A, Allemandi L, Assery O, et al. 2018 Global nutrition report: shining a light to spur action on nutrition. Bristol: Development Initiatives; 2019. World Health Organization, UNICEF, World Bank Group. Levels and trends in child malnutrition: key findings of the 2020 edition. Geneva: WHO; 2020. Appiah PK, Dzata WM, Bonchel DA, Korklu ARN, Ayeley DJN, Fenu GA, et al. Mothers’ adherence to global infant and young child feeding strategies in Ketu North District, Volta Region-Ghana. Eur Sci J. 2017;13(30):183–98. UNICEF. Division of Communication. Tracking progress on child and maternal nutrition: a survival and development priority. New York: UNICEF; 2009. Pradhan I, Kandapan B, Pradhan J. Age-appropriate feeding practices and their association with undernutrition among children aged 6–23 months in aspirational districts of India: a multinomial analysis. J Biosoc Sci. 2021;1–21. UNICEF. Programming guidance: infant and young child feeding. New York: UNICEF; 2021. Abate KH, Belachew T. Mothers’ knowledge and practice of responsive feeding and associated factors in rural Ethiopia. Pediatr Health Med Ther. 2017;8:59–67. Kim SS, Rawat R, Mwangi EM, Tesfaye R, Abebe Y, Baker J, et al. Exposure to large-scale social and behavior change communication interventions is associated with improvements in infant and young child feeding practices in Ethiopia. Matern Child Nutr. 2016;12(2):204–17. Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al; Maternal and Child Nutrition Study Group. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77. Nahar B, Hossain MI, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Early feeding practices and child growth: evidence from a community-based study in rural Bangladesh. Public Health Nutr. 2012;15(9):1582–9. Sanghvi T, Seidel R, Baker J, Jimerson A. Evidence-based approaches to improve infant and young child nutrition. Food Nutr Bull. 2013;34(3_suppl2):S169–80. Lamstein S, Stillman T, Koniz-Booher P, Aakesson A, Collaiezzi B, Williams T, et al. Evidence of effective approaches to social and behavior change communication for preventing and reducing stunting and anemia. Arlington, VA: USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project; 2014. Lazarus R, Struthers H, Violari A. Promoting safe infant feeding practices—the importance of structural, social and contextual factors in Southern Africa. J Int AIDS Soc. 2013;16(1):17433. Redsell SA, Slater V, Rose J, Olander EK, Matvienko-Sikar K. Barriers and enablers to caregivers’ responsive feeding behaviour: a systematic review to inform childhood obesity prevention. Obes Rev. 2021;22(7):e13228. Kalra N, Pelto G, Tawiah C, Zobrist S, Milani P, Manu G, et al. Patterns of cultural consensus and intracultural diversity in Ghanaian complementary feeding practices. Matern Child Nutr. 2018;14(1):e12445. Nti CA, Lartey A. Effect of caregiver feeding behaviours on child nutritional status in rural Ghana. Int J Consum Stud. 2007;31(3):303–9. Kim SS, Nguyen PH, Yohannes Y, Abebe Y, Tharaney M, Drummond E, et al. Behavior change interventions delivered through interpersonal communication, agricultural activities, community mobilization, and mass media increase complementary feeding practices and reduce child stunting in Ethiopia. J Nutr. 2019;149(8):1470–81. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1QuestionnaireEnglish.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 26 Mar, 2026 Reviews received at journal 31 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers invited by journal 01 Oct, 2025 Editor assigned by journal 01 Oct, 2025 Editor invited by journal 29 Sep, 2025 Submission checks completed at journal 28 Sep, 2025 First submitted to journal 28 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7541937","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528060831,"identity":"ff3315f4-9443-4fcd-a524-6ef260d3d757","order_by":0,"name":"Akosua Achiaa 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class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among children under 24 months, stunting and other forms of undernutrition are influenced not only by dietary intake and disease exposure but also by how feeding is practiced [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Increasingly, feeding behaviours\u0026mdash;especially the quality of caregiver-child interaction during feeding\u0026mdash;are being recognized as a vital determinant of survival, growth, and development [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eResponsive Feeding (RF)\u003c/em\u003e, as defined by the World Health Organization (WHO) and UNICEF, is a cornerstone of recommended Infant and Young Child Feeding (IYCF) practices [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is embedded within the broader framework of psychosocial care and includes practices such as recognizing and responding to a child\u0026rsquo;s hunger and satiety cues, avoiding force-feeding, providing encouragement without coercion, and creating a positive feeding environment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Responsive feeding is particularly important during the transition from exclusive breastfeeding to complementary feeding, as children begin to establish lifelong eating patterns and food preferences.\u003c/p\u003e\u003cp\u003eDespite its proven importance, the implementation of responsive feeding remains a challenge in many low- and middle-income countries (LMICs), including Ghana [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Caregivers often lack awareness or understanding of RF principles, and socio-cultural norms, time constraints, food insecurity, and limited support systems can hinder their practice [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies across various LMIC settings have reported that RF practices are suboptimal and poorly understood [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For example, a study in Ethiopia found that only 17% of caregivers demonstrated adequate responsive feeding behaviours, with maternal education and access to counselling services emerging as strong predictors of good practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, research in Bangladesh linked responsive feeding to better dietary diversity and improved growth outcomes, and emphasized the role of maternal knowledge, autonomy, and emotional well-being [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBehaviour Change Communication (BCC) strategies have emerged as key tools in promoting optimal IYCF practices, including RF [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. BCC interventions aim to influence individual and community behaviours through targeted communication methods such as counselling, demonstrations, mass media, and peer support [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. When appropriately designed and delivered, BCC interventions can be highly cost-effective and impactful in improving maternal knowledge and practices related to child nutrition [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Nevertheless, while the utility of BCC is widely acknowledged, evidence on its specific contribution to enhancing responsive feeding remains limited. Much of the existing literature focuses on dietary intake or breastfeeding, with fewer studies examining the nuanced behavioural and psychosocial aspects of feeding interactions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Building on global recommendations and emerging evidence of the effectiveness of BCC in improving child nutrition, this study assessed the impact of a structured BCC intervention\u0026mdash;grounded in WHO complementary feeding guidelines\u0026mdash;on the responsive feeding and Feeding During Illness and Recovery (FDIR) practices of caregivers of children aged 6\u0026ndash;23 months in the Bosomtwe District of Ghana. By focusing on how caregivers engage with their children during feeding, this study contributes to the growing body of knowledge on how communication-based interventions can influence not just what children eat, but how they are fed\u0026mdash;an equally critical component of child nutrition and well-being.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eThe study design is a community-based non-randomised controlled trial which was carried out in the Bosomtwe district of the Ashanti region of Ghana. The Bosomtwe District is one of the twenty-seven (27) districts that make up Ghana's Ashanti Region. A mixed method approach including structured questionnaires, interviews with mothers, and BCC were used for data collection at baseline and six months post-intervention. Eleven Child Warefare Clinics (CWCs) were purposively selected for the study. All eleven CWCs were eligible for a World Food Programme (WFP)/ Ghana Health Service (GHS) collaborative BCC intervention. However, to enable this study, 5 CWCs had to serve as controls while the first group of six CWCs were allocated to the BCC intervention. After the post-intervention survey, the other five CWCs were provided the intervention.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy sample and selection process\u003c/h3\u003e\n\u003cp\u003eThe study included mothers and their children between the ages of 6 to 17 months at baseline and six months post intervention. The children were 6\u0026ndash;17 months at baseline and so post intervention, the minimum age was 12 months and maximum age was 23 months. In each CWC, mothers-children pairs within the required age in the CWC registers were eligible for recruitment. Announcements were made for caregivers/mothers to visit the CWC on some chosen dates. Study enumerators recruited caregivers/mothers who turned up on these chosen dates. Mothers who were unwilling to participate, had a child younger than 6 months or older than 17 months for the baseline study, or had not begun complementary feeding even though their children six months or above were also excluded. 525 mother-infant pairs were recruited for the baseline survey. At post-intervention, 391 respondents were available to participate in the assessment, giving a follow-up rate of 74.5%. When grouped into intervention and control, 322 mother-child were in the intervention group and 203 of the controls were recruited at baseline while 247 (76.7%) intervention and 145 (71.4%) controls completed the follow study.\u003c/p\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eData were collected digitally using tablets and an electronic format of questionnaires on Surveybe app tool. A structured questionnaire was developed by the study team specifically for this study to capture caregiver and child sociodemographic information, feeding practices, exposure to the behaviour change communication (BCC) intervention, and responsive-feeding behaviours. The questionnaire is provided as Supplementary File 1. In-person interviews were done with mothers and children aged 6 to 17 months who were present at the CWCs.\u003c/p\u003e\n\u003ch3\u003eRecruitment and training of field staff\u003c/h3\u003e\n\u003cp\u003eTen (10) enumerators, four nutritionists, and two lab technicians were recruited for the survey. The supervisors spent two days training the enumerators to understand the questionnaires and conduct the interviews using the Surveybe app tool installed on an Android Huawei tablet. At the end of each day, the supervisors double-checked all questionnaires to ensure consistency and completeness.\u003c/p\u003e\n\u003ch3\u003eBaseline study\u003c/h3\u003e\n\u003cp\u003eThe Baseline Household Survey was conducted in August, 2020. This was conducted on responsive feeding practices, and complementary feeding practices of the mother-child pairs in both intervention and control CWCs.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eBaseline assessment of responsive feeding practices\u003c/h2\u003e\u003cp\u003eA 5-item questionnaire was used to determine responsive feeding practices among mothers. The scale asked twenty-one (21) Yes/No questions about responsive feeding practices. The variables \"fed slowly and patiently,\" \"fed child's favourite food,\" \"breastfed on demand,\" \"stopped feeding,\" \"force-fed child,\" and \"punished child\" were measured as ways among the several elements of responsive feeding practices that mothers or primary caregivers use when introducing their children to new food and when their children lost appetite. Among the several elements of responsive feeding mother or primary caregiver use when the child refuses to eat a meal, the variables \"gave alternative/changed food\", \"breastfed, gave solid food, breastfed again\", \"talked to child\", \"sang to child\", \"force-fed child\", \"stopped feeding\" and \"punished child\" were measured. A multiple-response questionnaire required the enumerator to mark all of the feeding practices indicated by the mother or primary caregiver. Mothers or primary caregivers were asked to respond to practices associated with each feeding style by data collectors. However, because many mothers or primary caregivers used more than one feeding style, they were classified into three responsive feeding practices (good, moderate, or low) based on their overall responsive feeding score. In addition to the overall responsive feeding score, good practices (10 Yes/No questions were graded 1 for Yes and 0 for No) and bad practices (11 Yes/No questions were graded 1 for No and 0 for Yes) were evaluated. As a result, mothers or primary caregivers who practiced a specific style the majority of the time for responsive feeding items were scored with 15 to 21, 8 to 14, and 0 to 7, respectively, and were considered to have good, moderate, or low responsive feeding practices depending on the response to each item. The questions were chosen in accordance with WHO\u0026rsquo;s guiding principles for complementary feeding as taught in the various CWCs. Questions were translated and back-translated, and they were piloted to make sure that they were easily understood, and those open-ended questions triggered appropriate responses.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBCC Intervention\u003c/h3\u003e\n\u003cp\u003eHealth care workers (HCWs) in the six CWCs allocated the intervention were trained to provide BCC on IYCF practices. The BCC training was held for 3 days and provided by resource persons from the Ghana Health Service. The BCC training involved breastfeeding initiation, exclusive breastfeeding and appropriate complementary feeding recommendations. Following the training, HCW used the knowledge, understanding and skills they had obtained to counsel mothers and caregivers in the six intervention CWCs. The HCWs provided monthly counselling when mothers and caregivers attended CWC sessions and answered questions and clarifications of the mothers/caregivers. In addition, the trained enumerators at baseline also counselled mothers/caregivers on IYCF guidelines. HCWs working in the five control CWCs did not receive the BCC training for this first six months. The study enumerators did not provide and reinforcement messages to mothers/caregivers from the CWCs that served as controls. Follow-up phone calls were made in November, 2020 to the intervention caregivers/mothers. The aims of the calls were to verify the compliance of the information received, address any questions caregivers or mothers may have, and reinforce the BCC messages. An interventions compliance questionnaire scale of 1 to 10 (1 being the minimum and 10 being the maximum) were asked to ascertain the levels of compliance of respondents.\u003c/p\u003e\n\u003ch3\u003ePost intervention assessment\u003c/h3\u003e\n\u003cp\u003eCaregivers/mothers were surveyed after 6 months post intervention. All the baseline data collected were repeated.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe research data collected in the field was processed and analyzed through a series of stages. They were screened, sorted, cross-checked and verified to ensure that there were no errors or missing values in the data entry. Data entry, management, and analysis were carried out using Statistical Product for Service Solution (SPSS) version 26 and R statistical software for descriptive statistics. A Pearson\u0026rsquo;s chi-square test, cross-tabulation was used to compare the frequencies of socio-demographic characteristics, maternal perception of child's nutritional status, maternal hygiene practices, and start of complementary feeding, maternal knowledge and practices of using Protein Micronutrient powder (PMP), child's symptoms, hunger, and poverty status by intervention group, responsive feeding practices, and feeding during illness and recovery. Crude models, Mann-Whitney U tests and paired sample T-tests were also used to calculate the significance of the dependent variable and various independent variables of interest. Linear regression analysis was also used at the 5% significance level to investigate factors related to responsive feeding practices among the sampled mothers, and the impact of nutrition education on responsive feeding practices among the sample children. To compare the various independent and dependent variables, standard deviations and means were also used. Tables were used to present the findings.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Characteristics of Mothers and Children\u003c/h2\u003e\u003cp\u003eThe majority of mothers in both the intervention and non-intervention groups were aged 18 years and above\u0026mdash;97.2% and 98.5%, respectively\u0026mdash;with a mean age of 29 years (range: 16\u0026ndash;47). Slightly more teenage mothers were present in the intervention group (2.8%) than in the control group (1.5%).\u003c/p\u003e\u003cp\u003eUnemployment was higher among non-intervention mothers (34.5%) than among those in the intervention group (26.4%). Additionally, a significantly higher proportion of intervention mothers (45.6%) experienced moderate-to-high lived poverty compared to non-intervention mothers (41.9%) (p\u0026thinsp;=\u0026thinsp;0.013). Other socio-demographic variables, such as education level and household hunger status, showed no significant differences between the groups.\u003c/p\u003e\u003cp\u003eAmong the children, male representation was higher in both groups (63.6% in the intervention group and 59.2% in the control group). The age distribution was also similar between groups, with most children falling within the 12\u0026ndash;17 months age range and a mean age of 11.4 months.\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio demographic characteristics of mothers and children among the two intervention groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-intervention n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX-Squared\u003c/p\u003e\u003cp\u003e(P-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender of children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.1(0.296)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e161(63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92(36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e272\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e161(59.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e111(40.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.2(0.691)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 to 11 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164(60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e107(39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 to 17 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e158(62.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96(37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean age in months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e6\u0026ndash;17\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of Mothers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0(0.325)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9(2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3(1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e313(97.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e200(98.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean age in years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e16\u0026ndash;47\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.4(0.066)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp To Basic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61(18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26(12.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove Basic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e438\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e261(81.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e177(87.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.9 (0.048)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e370\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e237(73.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e133(65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85(26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e70(34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLPI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.8(0.013)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175(54.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e118(58.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77(23.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28(13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70(21.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57(28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHHS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.3(0.071)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo hunger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e167(51.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86(42.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate Hunger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61(18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40(19.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere Hunger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94(29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77(37.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eData are reported as frequency (percentage), Chi square (X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e), P-values are reported, P-value is significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eResponsive Feeding Practices at Baseline and Post-Intervention\u003c/h2\u003e\u003cp\u003eAt baseline, the vast majority of mothers (93.7%) exhibited poor responsive feeding practices. Only 6.3% had good practices. Six months after the intervention, the proportion of mothers with good feeding practices increased significantly to 41.7%, while those with poor practices decreased to 58.3% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eIn terms of severity, 58.5% of mothers had moderate responsive feeding practices and 35.2% had low levels at baseline. By post-intervention, moderate feeding practices had declined to 43%, and low levels dropped markedly to 15.3%, indicating a significant overall improvement in responsive feeding behaviors (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssessment of responsive feeding practice among mothers at baseline and post intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRFP categories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChi-Square\u003c/p\u003e\u003cp\u003e(X\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRFP severity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e174.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163(41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e307(58.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e168(43.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e185(35.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60(15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRFP status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e167.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163(41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e492(93.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e228(58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e525(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e391(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eThe data were represented in proportions, with the percentage in parenthesis. The Pearson Chi-Square (X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e) tests were used to compare the proportions. (*) represents significant statistical association at p˃0.05 (Categories low\u0026thinsp;=\u0026thinsp;0\u0026ndash;7, moderate\u0026thinsp;=\u0026thinsp;8\u0026ndash;14, good\u0026thinsp;=\u0026thinsp;15\u0026ndash;21, Bad\u0026thinsp;=\u0026thinsp;0\u0026ndash;14)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSocio-Demographic Characteristics and Feeding Practices\u003c/h2\u003e\u003cp\u003eAt baseline, all mothers under 18 years of age (100%) practiced poor responsive feeding, compared with 93.6% among those aged 18 years and older, a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.036). By the end of the intervention, poor feeding practices had declined to 45.5% among teenage mothers and to 58.7% among older mothers.\u003c/p\u003e\u003cp\u003eEducation level did not significantly influence feeding practices at either baseline or endline. At baseline, 92.0% of mothers with basic education and 94.1% with education above basic practiced poor feeding. At endline, poor practices were reported in 51.5% of mothers with basic education and 59.7% of those with higher education.\u003c/p\u003e\u003cp\u003eEmployment status was also not significantly associated with responsive feeding. At baseline, poor practices were reported by 93.5% of employed mothers and 94.2% of unemployed ones. After the intervention, poor feeding practices reduced to 56.5% among employed mothers and to 63.2% among unemployed ones.\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of maternal socio-demographic features and responsive feeding practices at baseline and post interventionpost-intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eResponsive Feeding Practice\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(P-value)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eResponsive Feeding Practice\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(P-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMothers Age Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.8(0.364)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.8(0.380)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5(45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6(54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\)\u003c/span\u003e\u003c/span\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e480(93.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33(6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e223(58.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e157(41.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e525\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e492(93.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e391\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e228(58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e163(41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.5(0.459)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.5(0.219)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to Basic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80(92.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e34(51.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e32(48.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove Basic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e438\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e412(94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e194(59.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e131(40.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.1(0.770)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003cp\u003e(0.231)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e370\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e346(93.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e161(56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e124(43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146(94.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e67(63.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39(36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cem\u003eThe data were represented in proportions, with the percentage in parenthesis. The Pearson Chi-Square (X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e) tests were used to compare the proportions. (*) represents significant statistical association at p˃0.05 (Categories bad\u0026thinsp;=\u0026thinsp;0\u0026ndash;14, good\u0026thinsp;=\u0026thinsp;15\u0026ndash;21)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eOther Determinants of Feeding Practices\u003c/h2\u003e\u003cp\u003eAt baseline, the only significant factor associated with responsive feeding was feeding during illness and recovery. Mothers who practiced appropriate feeding during these periods were significantly more likely to exhibit good feeding practices (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant associations were found between feeding practices and maternal perception of child\u0026rsquo;s nutritional status, child\u0026rsquo;s symptoms, age at complementary feeding initiation, purchasing of commercial fortified foods, handwashing behaviors, knowledge or use of PMP, or household poverty or hunger status.\u003c/p\u003e\u003cp\u003eBy post-intervention, several new associations emerged. Mothers\u0026rsquo; perception of their child\u0026rsquo;s nutritional status was significantly linked to responsive feeding (p\u0026thinsp;=\u0026thinsp;0.033). Mothers who believed their child was healthy were more likely to practice good feeding. Child symptoms were also significantly associated with feeding practices (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with mothers of symptomatic children showing poorer practices.\u003c/p\u003e\u003cp\u003eHand washing before feeding (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and before meal preparation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were both strongly associated with better responsive feeding practices. Additionally, mothers who had knowledge of PMP (p\u0026thinsp;=\u0026thinsp;0.012) and those who practiced its use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly more likely to feed responsively.\u003c/p\u003e\u003cp\u003eHowever, no significant associations were observed between post-intervention feeding practices and complementary feeding start time, purchase of commercial fortified foods, household hunger, or poverty status.\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship between other factors and responsive feeding practices at baseline and post intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eResponsive Feeding Practice\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(P-value)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eResponsive Feeding Practice\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(P-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMother\u0026rsquo;s Perception\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003cp\u003e(0.310)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003cp\u003e(0.033)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e407(94.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e201(56.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e154(43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85(91.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27(75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChild symptoms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003cp\u003e(0.263)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e68.6\u003c/p\u003e\u003cp\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt least one\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e330(94.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e161(77.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46(22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162(92.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e67(36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e117(63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFDIRs\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e88.5\u003c/p\u003e\u003cp\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003cp\u003e(0.738)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e486(95.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e153(57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e112(42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75(59.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e51(40.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLPI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.6(0.756)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.7(0.704)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e273(92.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e125(60.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e83(39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100(95.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45(54.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37(45.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119(93.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58(57.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43(42.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHHS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2 (0.925)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.9 (0.380)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Hunger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e236(93.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e104(55.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e84(44.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate Hunger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95(94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45(57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33(42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere Hunger\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161(94.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79(63.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46(36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHand wash before feeding\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003cp\u003e(0.356)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e34.1\u003c/p\u003e\u003cp\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes, all the time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e364(94.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22(5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e157(50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e152(49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128(92.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e71(86.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(13.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHand wash before preparing meal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003cp\u003e(0.533)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e25.1\u003c/p\u003e\u003cp\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes, all the time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e367(94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e151(51.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e144(48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125(92.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e77(80.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19(19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStart CF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003cp\u003e(0.502)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003cp\u003e(0.597)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;6months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162(94.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80(60.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e53(39.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;6months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e330(93.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e148(57.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e110(42.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverall purchase CFF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003cp\u003e(0.645)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003cp\u003e(0.293)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(95.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11(47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt least one\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e451(93.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e217(59.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e151(41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKnowledge of PMP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003cp\u003e(0.515)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6.3\u003c/p\u003e\u003cp\u003e(0.012)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e210(92.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e192(56.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e151(44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e282(94.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e36(75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePractice using PMP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003cp\u003e(0.896)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e53.2\u003c/p\u003e\u003cp\u003e(\u0026lt;\u0026thinsp;0.001)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94(94.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e87(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e123(58.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e398(93.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e141(77.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40(22.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cem\u003eThe data were represented in proportions, with the percentage in parenthesis. The chi square (X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e) test was used to compare the proportions. (*) represents significant statistical association at p˃0.05 (Categories bad\u0026thinsp;=\u0026thinsp;0\u0026ndash;14, good\u0026thinsp;=\u0026thinsp;15\u0026ndash;21)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.5. Effect of Social and Behavior Change Communication (SBCC)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt baseline, there was no statistically significant difference in responsive feeding practices between mothers in the intervention and control groups. Poor practices were observed in 94.4% of the intervention group and 92.6% of the control group (p\u0026thinsp;=\u0026thinsp;0.408).\u003c/p\u003e\u003cp\u003eAfter six months of SBCC intervention, poor feeding practices decreased substantially in the intervention group to 40.2%, while they remained high at 86.8% in the control group. This difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eImpact of SBCC on responsive feeding practices at baseline and post intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(p-value)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePost intervention\u003c/p\u003e\u003cp\u003eReceived SBCC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e(p-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResponsive feeding practice\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eIntervention group\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(0.408)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eIntervention group\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eControl\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003en(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e83.3 (\u0026lt;\u0026thinsp;0.001)*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e304 (94.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188 (92.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e132 (86.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e143 (59.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (13.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e322 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e203 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e239 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e152(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFrequency (percentage) are reported, chi-square(X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e) values are reported, and p-values are significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e\u003cp\u003eLogistic regression analysis confirmed the positive impact of the intervention. At baseline, SBCC exposure did not significantly influence feeding behavior (OR\u0026thinsp;=\u0026thinsp;0.7; p\u0026thinsp;=\u0026thinsp;0.410; 95% CI\u0026thinsp;=\u0026thinsp;0.4\u0026ndash;1.5). However, after the intervention, mothers who received SBCC were nearly 10 times more likely to practice good responsive feeding (OR\u0026thinsp;=\u0026thinsp;9.8; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 95% CI\u0026thinsp;=\u0026thinsp;5.7\u0026ndash;16.8).\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression analysis of impact of SBCC on responsive feeding practices among mothers at baseline and post intervention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eGood responsive feeding practice\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003ePost Intervention\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSBCC\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.4\u0026ndash;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.7\u0026ndash;16.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eDifferences in Mean Feeding Scores\u003c/h2\u003e\u003cp\u003ePaired sample t-test analysis showed significant improvements in mean responsive feeding practice scores in both groups. Among the intervention group, the mean score increased from 6.87 to 15.32, with a mean difference of +\u0026thinsp;8.45 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the non-intervention group, scores increased from 6.84 to 8.40, with a smaller but still significant mean difference of +\u0026thinsp;1.53 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results further reinforce the effectiveness of the SBCC intervention.\u003c/p\u003e\u003cp\u003e\u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean comparisons and paired sample T-test analysis of responsive feeding practices between the two intervention groups at both baseline and Endline\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003emean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNon-intervention\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEndline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study involved 525 mother\u0026ndash;child pairs. The mean age of participating mothers was 29 years, with a range from 16 to 47 years. These findings are consistent with those of Lazarus et al., whose study in South Africa included mothers of similar age [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Regarding educational attainment, 18.9% of mothers in the intervention group had only basic education, while 81.1% had progressed beyond basic level. Among non-intervention mothers, 12.8% had only basic education, and 87.2% had continued their education.\u003c/p\u003e\u003cp\u003eThe mean age of children in this study was 11.4 months, which aligns closely with findings from Redsell, who investigated factors influencing caregivers' responsive feeding behavior [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The majority of children in the intervention group (62.2%) were aged 12 to 17 months, while 60.5% were aged 6 to 11 months. Male children were more represented in the intervention group (63.6%) compared to the control group (36.4%).\u003c/p\u003e\u003cp\u003eAt baseline, 35.2% of mothers practiced low-level responsive feeding, and 58.5% practiced moderate-level responsive feeding. After six months of intervention, these figures dropped significantly to 15.3% and 43%, respectively. Overall, 93.7% of mothers exhibited poor responsive feeding practices at baseline, which improved significantly to 58.3% after the intervention.\u003c/p\u003e\u003cp\u003eConsistent with Kalra et al., this study identified maternal characteristics\u0026mdash;such as age, education, and employment\u0026mdash;as important factors influencing responsive feeding practices [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. At baseline, 5.9% of mothers with education beyond basic level and 8% of those with only basic education practiced good responsive feeding. Post-intervention, 40.3% of mothers with higher education and 48.5% of those with basic education practiced good feeding. Employment also played a role: at baseline, 6.5% of employed mothers and 5.8% of unemployed mothers practiced good feeding. After the intervention, these figures increased to 43.5% and 36.8%, respectively.\u003c/p\u003e\u003cp\u003eAt baseline, 5.8% of mothers with a positive perception of their child\u0026rsquo;s nutritional status practiced good feeding. Among children with at least one symptom of illness, 5.4% were fed responsively. Additionally, 62.5% of mothers who practiced appropriate feeding during illness and recovery demonstrated good feeding behavior. However, differences in feeding practices based on household poverty or hunger levels were not statistically significant.\u003c/p\u003e\u003cp\u003eAfter the intervention, several factors were significantly associated with improved feeding. Among mothers who had a positive perception of their child's nutritional status, 43.4% practiced good feeding. Similarly, 22.2% of mothers with symptomatic children, 49.2% of mothers who consistently washed their hands before feeding, and 48.8% who consistently washed hands before meal preparation practiced good feeding. Additionally, 44% of mothers with knowledge of the use of a fortified food supplement (PMP) and 58.6% who actually used it demonstrated good responsive feeding practices.\u003c/p\u003e\u003cp\u003eThese results echo the findings of studies, who reported that income and nutritional knowledge influence maternal readiness to adopt responsive feeding [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Redsell et al. similarly noted that childhood illnesses such as fever, vomiting, and diarrhea can trigger increased feeding responsiveness from caregivers, who interpret crying or signs of discomfort as hunger cues. In that study, 65% of mothers whose children were ill reported feeding them even without clear signs of hunger [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAt baseline, mothers who failed to feed their children appropriately during illness and recovery were significantly less likely to practice good feeding (OR\u0026thinsp;=\u0026thinsp;0.03). Post-intervention, mothers with negative perceptions of their child\u0026rsquo;s nutritional status had lower odds (OR\u0026thinsp;=\u0026thinsp;0.4) of practicing good feeding, and those whose children experienced illness had similarly reduced odds. Mothers who did not wash hands before feeding and meal preparation had odds of 0.2 and 0.3, respectively, for practicing good feeding. Similarly, those with no knowledge or use of the PMP supplement had 0.4 and 0.2 lower odds of good responsive feeding, respectively.\u003c/p\u003e\u003cp\u003eImportantly, the intervention\u0026mdash;particularly the social behavior change communication (SBCC) component\u0026mdash;was effective in promoting improved child feeding practices [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The six-month SBCC intervention led to a shift from poor to good practices across multiple indicators, suggesting that the promoted behaviors were acceptable and culturally compatible despite initial low adherence.\u003c/p\u003e\u003cp\u003eThe study found that SBCC had a strong positive impact on responsive feeding practices among mothers in the intervention group. Although the control group also showed a slight positive change, it is possible that mothers in both groups interacted in the same communities, leading to some cross-sharing of information. This potential contamination may partially explain the slight improvement in the control group.\u003c/p\u003e\u003cp\u003eThese findings are consistent with Kim et al., who demonstrated that implementing SBCC strategies across multiple platforms is both feasible and effective, resulting in improved responsive feeding behaviors over a two-year period [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations of the Study\u003c/h2\u003e\u003cp\u003eThis study was limited to mothers with children aged 6 to 23 months residing in the Bosomtwe District. Therefore, the findings may not be generalizable to other districts within the Ashanti Region or across Ghana.\u003c/p\u003e\u003cp\u003eAdditionally, due to the mobile nature of the population, some mothers who participated at baseline were unavailable for follow-up or dropped out before completing the intervention. This attrition led to a reduced sample size at the end of the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study demonstrated that behavior change communication (BCC) based on WHO guidelines for appropriate complementary feeding significantly improved responsive feeding practices and feeding during illness and recovery among mothers of young children in the Ashanti Region, Ghana.\u003c/p\u003e\u003cp\u003eThe findings underscore the potential of BCC to improve maternal feeding practices, contributing to better child nutrition outcomes. Furthermore, the results highlight the importance of monitoring and evaluating behavior change interventions to fully understand their impact at the district level, inform program design, and scale up best practices in maternal and child nutrition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eBCC\u003c/strong\u003e: Behaviour Change Communication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCF\u003c/strong\u003e: \u0026nbsp;Complementary Feeding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFDIR\u003c/strong\u003e: Feeding During Illness and Recovery\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGHS\u003c/strong\u003e: Ghana Health Service\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHCW\u003c/strong\u003e: Health care worker\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHHS\u003c/strong\u003e: Household Hunger Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIYCF\u003c/strong\u003e: Infant and Young Child Feeding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLMICs\u003c/strong\u003e: Low- and middle-income countries\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLPI\u003c/strong\u003e: Lived Poverty Index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNBCC\u003c/strong\u003e: Nutrition Behaviour Change Communication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePMP\u003c/strong\u003e: Protein Micronutrient powder\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRF\u003c/strong\u003e: Responsive Feeding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSBCC\u003c/strong\u003e: Social Behaviour Change Communication (BCC)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNICEF\u003c/strong\u003e: United Nations Children's Fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e: World Health Organization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWFP\u003c/strong\u003e: World Food Programme\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. A general ethical approval letter and consent form was obtained from both the Committee on Human Research Publication and Ethics (CHRPE), the School of Medical Science, Kwame Nkrumah University of Science and Technology, and the District Health Director (Approval no: CHRPE/AP/231/20). Trained enumerators explained the purpose of the study to the participants in the health center. Written and signed informed consent was obtained from all participants following the CHRPE protocol prior to the study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no external funding and self-funded all research costs for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRAA, CA, SO, and TS made substantial contributions to the conception, design, and implementation of the study. AAA, LNEA, and GOA did data collection and data analysis. RAA and AAA made substantial contributions to data analysis and the draft of the manuscript. All authors read and approved the final draft of the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to acknowledge the health director and the community nutritionist in the Bosomtwe district for supporting the implementation of the research. Also, we appreciate all the enumerators, healthcare workers, and nurses at the various CWCs for their immense support in collecting the data for the study. To all the caregivers and children who participated in the study, we are very grateful to you for your time and patience. Thank you all.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEngle PL, Menon P, Haddad L. Care and nutrition: concepts and measurement. World Dev. 1999;27(8):1309\u0026ndash;37.\u003c/li\u003e\n\u003cli\u003eEngle PL, Bentley M, Pelto G. The role of care in nutrition programmes: current research and a research agenda. Proc Nutr Soc. 2000;59(1):25\u0026ndash;35.\u003c/li\u003e\n\u003cli\u003eRogers E, Bell L, Mehta K. Exploring the role of grandparents in the feeding of grandchildren aged 1\u0026ndash;5 years. J Nutr Educ Behav. 2019;51(3):300\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eMahgoub SE, Nnyepi M, Bandeke T. Factors affecting prevalence of malnutrition among children under three years of age in Botswana. Afr J Food Agric Nutr Dev. 2006;6(1):1\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eMaradzika J, Makwara IP, Chipunza S. Factors associated with stunting among children aged 0 to 59 months in Harare city, Zimbabwe. Int J Child Health Nutr. 2016;5(1):31\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eEngle PL, Pelto GH. Responsive feeding: implications for policy and program implementation. J Nutr. 2011;141(3):508\u0026ndash;11. doi:10.3945/jn.110.130039.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: WHO; 2018.\u003c/li\u003e\n\u003cli\u003eBlack RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427\u0026ndash;51. doi:10.1016/S0140-6736(13)60937-X.\u003c/li\u003e\n\u003cli\u003eFanzo J, Hawkes C, Udomkesmalee E, Afshin A, Allemandi L, Assery O, et al. 2018 Global nutrition report: shining a light to spur action on nutrition. Bristol: Development Initiatives; 2019.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization, UNICEF, World Bank Group. Levels and trends in child malnutrition: key findings of the 2020 edition. Geneva: WHO; 2020.\u003c/li\u003e\n\u003cli\u003eAppiah PK, Dzata WM, Bonchel DA, Korklu ARN, Ayeley DJN, Fenu GA, et al. Mothers\u0026rsquo; adherence to global infant and young child feeding strategies in Ketu North District, Volta Region-Ghana. Eur Sci J. 2017;13(30):183\u0026ndash;98.\u003c/li\u003e\n\u003cli\u003eUNICEF. Division of Communication. Tracking progress on child and maternal nutrition: a survival and development priority. New York: UNICEF; 2009.\u003c/li\u003e\n\u003cli\u003ePradhan I, Kandapan B, Pradhan J. Age-appropriate feeding practices and their association with undernutrition among children aged 6\u0026ndash;23 months in aspirational districts of India: a multinomial analysis. J Biosoc Sci. 2021;1\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eUNICEF. Programming guidance: infant and young child feeding. New York: UNICEF; 2021.\u003c/li\u003e\n\u003cli\u003eAbate KH, Belachew T. Mothers\u0026rsquo; knowledge and practice of responsive feeding and associated factors in rural Ethiopia. Pediatr Health Med Ther. 2017;8:59\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eKim SS, Rawat R, Mwangi EM, Tesfaye R, Abebe Y, Baker J, et al. Exposure to large-scale social and behavior change communication interventions is associated with improvements in infant and young child feeding practices in Ethiopia. Matern Child Nutr. 2016;12(2):204\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eBhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al; Maternal and Child Nutrition Study Group. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452\u0026ndash;77.\u003c/li\u003e\n\u003cli\u003eNahar B, Hossain MI, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Early feeding practices and child growth: evidence from a community-based study in rural Bangladesh. Public Health Nutr. 2012;15(9):1582\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eSanghvi T, Seidel R, Baker J, Jimerson A. Evidence-based approaches to improve infant and young child nutrition. Food Nutr Bull. 2013;34(3_suppl2):S169\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eLamstein S, Stillman T, Koniz-Booher P, Aakesson A, Collaiezzi B, Williams T, et al. Evidence of effective approaches to social and behavior change communication for preventing and reducing stunting and anemia. Arlington, VA: USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project; 2014.\u003c/li\u003e\n\u003cli\u003eLazarus R, Struthers H, Violari A. Promoting safe infant feeding practices\u0026mdash;the importance of structural, social and contextual factors in Southern Africa. J Int AIDS Soc. 2013;16(1):17433.\u003c/li\u003e\n\u003cli\u003eRedsell SA, Slater V, Rose J, Olander EK, Matvienko-Sikar K. Barriers and enablers to caregivers\u0026rsquo; responsive feeding behaviour: a systematic review to inform childhood obesity prevention. Obes Rev. 2021;22(7):e13228.\u003c/li\u003e\n\u003cli\u003eKalra N, Pelto G, Tawiah C, Zobrist S, Milani P, Manu G, et al. Patterns of cultural consensus and intracultural diversity in Ghanaian complementary feeding practices. Matern Child Nutr. 2018;14(1):e12445.\u003c/li\u003e\n\u003cli\u003eNti CA, Lartey A. Effect of caregiver feeding behaviours on child nutritional status in rural Ghana. Int J Consum Stud. 2007;31(3):303\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eKim SS, Nguyen PH, Yohannes Y, Abebe Y, Tharaney M, Drummond E, et al. Behavior change interventions delivered through interpersonal communication, agricultural activities, community mobilization, and mass media increase complementary feeding practices and reduce child stunting in Ethiopia. J Nutr. 2019;149(8):1470\u0026ndash;81.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"behaviour change communication, responsive feeding, caregivers, infants and young children, complementary feeding, child nutrition, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-7541937/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7541937/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOptimal infant and young child feeding is critical to healthy growth and cognitive development during the first two years of life. The World Health Organization\u0026rsquo;s Complementary Feeding (CF) guidelines emphasize not only \u003cem\u003ewhat\u003c/em\u003e to feed but also \u003cem\u003ehow\u003c/em\u003e, with Responsive Feeding (RF) being a key psychosocial component that encourages sensitive, non-coercive interactions that respond to children's hunger and satiety cues. This study examined the factors associated with RF and Feeding During Illness and Recovery (FDIR) practices, and evaluated the effect of a Nutrition Behaviour Change Communication (NBCC) intervention, aligned with WHO CF guidelines, on these practices among caregivers of children aged 6\u0026ndash;23 months in the Bosomtwe District of Ghana.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA total of 525 mother-infant pairs were recruited at baseline: 322 (61.3%) received the NBCC intervention while 203 (38.7%) served as controls. The six-month intervention included structured education, personalized counselling, and practical demonstrations on appropriate CF and RF. Data on RF and FDIR practices were collected pre- and post-intervention and analysed using Mann-Whitney U tests, paired t-tests, and logistic regression. At baseline, only 6.3% of caregivers demonstrated good RF practices, and a mere 3.0% practiced appropriate FDIR.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNo significant associations were observed between caregivers' socio-demographic characteristics and feeding practices. Importantly, caregivers with poor RF had markedly lower odds of practicing good FDIR (OR\u0026thinsp;=\u0026thinsp;0.03, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Pre-intervention RF practices were similarly poor across intervention (94.4%) and control groups (92.6%, p\u0026thinsp;=\u0026thinsp;0.408). However, post-intervention, the proportion of caregivers practicing poor RF reduced by over 50% in the NBCC group (to 40.2%) compared to only a marginal reduction in controls (86.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Improvements in FDIR mirrored these trends. Post-intervention, NBCC participation was strongly associated with reduced odds of poor RF (OR\u0026thinsp;=\u0026thinsp;0.1, 95% CI p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ), a reversal from baseline trends.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThese findings underscore the transformative potential of well-designed, context-sensitive behaviour change communication grounded in global best practices. Scaling up NBCC interventions aligned with WHO guidelines can substantially improve caregiver feeding behaviours, particularly in low-resource settings, thereby enhancing child health outcomes during this critical developmental window.\u003c/p\u003e","manuscriptTitle":"Impact of Behaviour Change Communication Intervention on Responsive Feeding Practices of Caregivers of Infants and Young Children, 6-23 months in Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-14 15:47:39","doi":"10.21203/rs.3.rs-7541937/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"40772866496851814336380393492823087868","date":"2026-03-26T10:47:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-31T12:58:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170719956985062198830984788706807239768","date":"2025-10-03T12:01:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-01T11:22:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-01T11:15:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-29T10:35:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-28T06:35:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2025-09-28T06:32:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6730cee-29c0-46da-bce7-7eea9ebeb49f","owner":[],"postedDate":"October 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T15:47:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-14 15:47:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7541937","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7541937","identity":"rs-7541937","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}