The effect of care groups on infant and young child feeding, dietary diversity and WASH behaviours in rural Zimbabwe: A case-control study

Background The care group model is a sustainable low cost community-based strategy to achieve nutrition related behaviour change and improve nutrition and diet quality indicators. Objective To evaluate the effect of the care groups on achieving positive infant and young child feeding, dietary diversity and WASH behaviours. Methods A case-control study utilised a mixed method approach targeting seven rural districts in Zimbabwe in June 2022. A structured questionnaire was used to collect data on IYCF, diet quality, WASH, and child morbidity. Binary logistic regression was used to evaluate the association between exposure (intervention) and outcome. Significance was at P<0.05. Results A total of 127 cases and 234 controls were enrolled. There was no significant difference between cases and controls on the prevalence of; diarrhoea (P=0.659), cough (P=0.191), and fever (P=0.916). No significant difference was observed in the proportion ever breastfed (P=0.609), diet quality-children with adequate dietary diversity score (CDDS) (P=0.606) across the two groups. However, the proportion of families with adequate Household Dietary Diversity Score (HDDS) (P=0.005) and minimum dietary diversity for women (MDD-W) (P=0.009) were significantly higher in cases than controls. Furthermore, the knowledge and practice of all promoted behaviours were significantly higher in the cases than in controls with exception of exclusive breastfeeding. Practice was significantly higher in cases compared to controls for: “Appropriate complementary feeding for children aged 6-24months” (P=0.001), “good nutrition for women of childbearing age” (P=0.001), “production and consumption of diverse nutritious food” (P=0.001) and “production and consumption of biofortified crops” (P=0.001). Conclusions The current results adds to the body of evidence showing that care groups are effective for achieving sustainable nutrition and WASH related behaviour change in a low-income setting. Overall, care groups should be implemented to scale ‘coverage” and integrated into existing community nutrition programs for maximum impact. Key Messages ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was implemented within the Principles of Helsinki Declaration that guide research involving human subjects. Approval to carryout research in the respective study districts was obtained from the District Development Coordinator office and the Ministry of Health and Child care (MoHCC) District Medical Directorate. Permission to access villages and households was obtained from the community leadership through consultative engagement process. Ethical approval was obtained from the Medical Research Council of Zimbabwe (MRCZ/B/2423). Informed consent was obtained from each participant before study procedures began. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The anonymised datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Email: tmatsungo{at}gmail.com