Background
Undernutrition during the 1,000 most critical days – pregnancy through the first 24 months of life – is a
particular risk factor for morbidity and mortality among infants and young children. Inadequate
knowledge about complementary foods and feeding practices is often the cause and can be a greater
determinant of undernutrition than lack of food. To help address undernutrition between 6 and 23
months of age, Catholic Relief Services (CRS) developed Community-led Complementary Feeding and
Learning Sessions (CCFLS), a preventive model building on the Positive Deviance (PD)/Hearth approach.
PD/Hearth is a home-based and community-based recuperative nutrition approach for children at risk
for protein-energy malnutrition in developing countries. CCFLS aims to enable households to improve
their nutrition through high-nutrient, low-cost and available foods. CRS Zambia leads the five-year
Mawa project, which aims to improve food and economic security for households in target communities
Chipata and Lundazi districts in Zambia’s Eastern Province. CCFLS is one component of Mawa’s
integrated approach and targets children at risk for underweight aged 6 to 23 months with a weight for
age (WAZ) Z score below 0 standard deviation (SD) and above -2 SD.
Research Question
What is the mean weight gain of Zambian children aged 6 to 23 months with a WAZ less than 0 SD and
greater than -2 SD who participate in CCFLS compared to the 400 gram weight gain expected under the
PD/Hearth model?
Methods
We analyzed child weight and length data collected by the CRS Mawa project during CCFLS sessions and
six-month follow up visits. All variables were analyzed using descriptive and multivariable analyses using
IBM SPSS Statistics Version 19. WHO Child Growth Standards SPSS Syntax File was used to calculate Z
scores. All variables were disaggregated by sex and age (6-11 months and 12-23 months).
Results
Out of 144 children in study, 91 were girls (63%), 56 were 6 to 11 months of age (39%) and 88 were 12
to 23 months (61%). By day 12 of CCFLS, the mean weight gain was 250 grams (290 for boys and 230 for
girls). Forty-six children (32%) had gained at least 400 grams (the target weight gain), with more boys
reaching 400 grams (42%) than girls (26%). The mean weight gain from day 1 of CCFLS to the six-month
follow up visit was 1,360 grams, with boys gaining slightly less than girls (1,260 to 1,420 grams
respectively). The mean six-month weight gain overall was 1% more than what would be expected per
the World Health Organization (WHO) child growth standards (1,350 grams); while the mean weight
gain for boys was 7% less than the WHO expected weight gain, the mean weight gain for girls was 5%
greater than the WHO expected weight gain. The mean six-month length gain was 4.7 cm, with 4.3 cm
for boys and 5 cm for girls. The mean six-month length gain was 27% lower than expected per the WHO
child growth standards, with the mean length gain for boys 33% less than WHO standards and the mean
six-month length gain for girls 25% less than the WHO standards.
Conclusion
Children participating in CCFLS generally demonstrated robust weight gain over the six-month follow up
period, i.e., mean ponderal growth relatively close to or exceeding the expected according to WHO
growth standards. Height gain was not as robust. This analysis calls into question whether the target
weight gain of 400 grams over the 12-day CCFLS sessions, a target weight gain which was carried over
from PD/Hearth, a recuperative program, is the most appropriate for CCFLS as a preventive intervention.
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Four hundred grams is much higher than what would be expected for children following a growth
trajectory based on WHO growth standards over a 12-day period. Despite study limitations related to
the lack of a comparison group, insufficient data quality, the small sample size, and unclear attribution
of six-month follow up data due to other Mawa and community interventions, these results indicate
that CCFLS is a promising intervention. Enrollment in the program is ongoing; more in-depth analysis of
Mawa CCFLS data is required to better understand the impact of the program.