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