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.
