Background Caregivers' knowledge, attitudes and practices (KAP) play a central role in infant feeding behaviors and the correct use of nutrition interventions such as micronutrient powder (MNP). Although nutrition education and MNP supplementation are routinely delivered through child health services in Mozambique, evidence on changes in caregivers' KAP in urban service settings remains limited. The aim of this study was to estimate the effect of a nutrition education intervention on caregivers' KAP regarding infant feeding and micronutrient powder use in two urban health centers in Maputo, Mozambique. Methods A quasi-experimental study was conducted among caregivers of infants aged 6–8 months attending routine child health consultations at two urban primary health centers. One facility implemented reinforced nutrition education, while the other provided standard nutrition education. Caregivers completed a structured KAP questionnaire at baseline and after 6 months of follow-up. Changes in knowledge were analyzed over time and between groups using difference-in-differences analysis. Attitudinal indicators were analyzed at the item level, and practices related to MNP use were assessed descriptively at endline in the intervention group only. Results A total of 466 caregivers were enrolled at baseline and 442 completed follow-up. Knowledge scores increased significantly from baseline to endline in both the intervention group (65.0% to 96.7%; p 0.001) and the control group (54.6% to 84.4%; p 0.001). Endline knowledge levels were higher in the intervention group ( p 0.001), although the magnitude of improvement did not differ significantly (difference-in-differences: +1.8 pp; p = 0.381). Attitudinal indicators improved in the intervention group, whereas several declined in the control group. Difference-in-differences results favored the intervention across attitudinal indicators (all p 0.001). At endline, all caregivers in the intervention group reported offering MNP to their children, with high adherence to daily administration and mostly correct preparation. Conclusions Strengthening nutrition education delivered through routine child health services was associated with improved caregivers' KAP related to infant feeding and MNP use. Universal uptake and high adherence to MNP indicate that home fortification can be adopted with counseling. These findings support child health programmes to promote recommended feeding practices and reduce micronutrient deficiencies.
Manuel et al. (Tue,) studied this question.
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