Effectiveness of Community-led Complementary Feeding and Learning Sessions (CCFLS) on child diet and nutritional status in Oromia, Ethiopia: A quasi-experimental cohort study.

内容摘要

Food insecurity and child undernutrition remain critical challenges in Ethiopia. Recent humanitarian financing reductions have increased interest in low-cost, scalable approaches for preventing acute malnutrition before treatment is required. To prevent acute malnutrition, the Community-led Complementary Feeding and Learning Sessions (CCFLS) approach targets children at risk of wasting through nutrition education, behavior change, and promotion of locally available foods. To assess the effectiveness of CCFLS on improving child feeding practices and reducing acute malnutrition risk. A quasi-experimental cohort study was conducted across 30 kebeles in Eastern Hararghe Zone, Oromia region, Ethiopia in 2024, enrolling 884 children age 6-23 months with MUAC 12.5-13.0 cm. Baseline data were collected immediately before intervention, with follow-up at three and six months. Three-level mixed-effect regression models estimated program effects on infant and young child feeding, MUAC, and wasting prevalence. CCFLS was associated with increases of 11.8 percentage points (pp) (95% CI: 4.8, 18.8) in children achieving minimum dietary diversity and 13.3pp (95% CI: 6.4, 20.3) achieving minimum acceptable diet six months after intervention. After adjusting for baseline MUAC, mean child MUAC increased 0.45cm (95% CI: 0.34, 0.55) more in the CCFLS group than in controls. CCFLS children had 89% (RR=0.11; 95% CI: 0.04, 0.32) lower risk of becoming wasted and were 1.40 times (95% CI: 1.14, 1.73) more likely to no longer being at risk of wasting. CCFLS was associated with improved dietary diversity, minimum acceptable diet, and child nutrition, with benefits sustained over six months. Findings suggest that CCFLS, a low-cost community-based nutrition intervention relying on locally available foods and existing health structures, can help prevent wasting while reducing demand for resource-intensive treatment services. In an era of constrained humanitarian financing, preventive approaches such as CCFLS may improve child nutrition outcomes while easing pressure on overstretched nutrition systems.