The impact and implementation of a mobile messaging intervention to improve infant and young child nutrition in Senegal

摘要 在婴儿出生后的头1000天内，采用不太理想的婴幼儿喂养(IYCF)做法 在他们两岁之前怀孕，是导致塞内加尔高营养不良率的原因之一。仅限 7%的塞内加尔儿童在6-23个月大时根据全球国际儿童年基金的建议进行喂养 儿童发育迟缓和微量营养素缺乏的高峰期。在这个时代改进国际儿童基金会的实践 该集团将促进健康的生长和发展，并帮助解决营养不良的负担。 社区卫生工作者(CHW)经常负责向塞内加尔的母亲提供国际儿童年咨询。 然而，由于时间和地理限制以及相互竞争的卫生优先事项，它们的覆盖范围有限。 使用替代交付平台，确定可行、有效和可扩展的国际青年会干预措施至关重要 改进国际青年会的做法。移动健康(MHealth)干预措施有望改善以下方面的交付差距 鉴于移动电话的普遍普及率，国际青年会在塞内加尔实行。然而，移动健康干预措施 塞内加尔尚未扩大这一解决国际年基金问题的范围。在我们之前在塞内加尔的工作中，我们进行了 设计和试点以用户为中心的mHealth IYCF语音消息干预的形成性研究 计划行为理论。移动健康干预，这是交付给母亲和父亲 6-23个月大的儿童对最低可接受饮食的摄入量增加了19.2% (MAD)，这是饮食多样性的一个指标。然而，需要对其影响进行更严格的评估。因此， 该项目的总体目标是进行有效性-实施混合设计研究(类型1)，以 检查mHealth IYCF消息传递干预的影响、实施和成本 以前的工作。首先，我们将对510名母亲、父亲和儿童三合会进行整群随机对照试验 在塞内加尔的102个村庄开展活动，以确定干预措施对国际儿童基金会做法和营养成果的影响 (目标1)。试验组将在16周内收到语音和短信。消息将 包括关键目标IYCF实践的脚本消息以及来自社区的非脚本消息 榜样(即“积极离经叛道者”)。在此之前，我们将测定儿童的贫血患病率和MAD。 干预实施后。我们还将研究实施情况、成本和机会 通过执行流程评估，使用混合的- 方法和经济分析。鉴于CHW面临的限制，提供关于以下方面的严格证据 有效、可行和负担得起的替代交付平台有可能扩大覆盖范围 并采纳国际年儿童基金会的建议做法，打破营养不良的循环。没有特定于环境的 尽管国际儿童基金会采取了有效的干预措施，但营养不良仍将是塞内加尔死亡和残疾的主要驱动因素。

Abstract Suboptimal infant and young child feeding (IYCF) practices in the first 1000 days, from the time a child is conceived until the time they are two years of age, is contributing to high rates of malnutrition in Senegal. Only 7% of Senegalese children are fed according to global IYCF recommendations from 6-23 months of age, the peak period for growth faltering and micronutrient deficiencies in children. Improving IYCF practices in this age group will promote healthy growth and development and help to address the burden of malnutrition. Community Health Workers (CHWs) are often tasked with delivering IYCF counseling to mothers in Senegal. However, their reach is limited due to time and geographical constraints as well as competing health priorities. Identifying feasible, effective, and scale-able IYCF interventions, using alternative delivery platforms, is critical to improve IYCF practices. Mobile health (mHealth) interventions show promise for improving delivery gaps for IYCF practices in Senegal, given the widespread mobile phone penetration. However, mHealth interventions that address IYCF have not yet been scaled-up in Senegal. In our prior work in Senegal, we conducted formative research to design and pilot a user-centered mHealth IYCF voice messaging intervention based on the theory of planned behavior. The mHealth intervention, which was delivered to both mothers and fathers of children aged 6-23 months, showed a 19.2% increase in the consumption of a minimum acceptable diet (MAD), an indicator of dietary diversity. However, a more rigorous evaluation of its impact is needed. Thus, the overall objective of this project is to conduct an effectiveness-implementation hybrid design study (type 1) to examine the impact, implementation, and costs of a mHealth IYCF messaging intervention that builds on our previous work. First, we will conduct a cluster-randomized control trial with 510 mother, father and child triads in 102 villages in Senegal to determine the impact of the intervention on IYCF practices and nutrition outcomes (Aim 1). The experimental group will receive voice and text messages for a period of 16 weeks. Messages will include both scripted messages of key target IYCF practices as well as unscripted messages from community role models (i.e., “positive deviants”). We will determine anemia prevalence and MAD in children before and after the intervention implementation. We will also examine the implementation, costs and opportunities for scaling-up the mHealth IYCF messaging intervention (Aim 2) by conducting a process evaluation, using mixed- methods, and an economic analysis. Given constraints faced by CHWs, providing rigorous evidence about alternative delivery platforms that are effective, feasible and affordable has the potential to improve the reach and uptake of recommended IYCF practices, breaking the cycle of malnutrition. Without context-specific effective IYCF interventions, malnutrition will continue to be the main driver of death and disability in Senegal.