Discussion
hearing ASF
SECONDARY
This study found that an SBCC intervention encouraging fathers in livestock-keeping households to support child nutrition increased the percentage of children who more frequently consumed ASFs, specifically milk, eggs, and beef. ASFs are important sources of protein, iron, zinc, vitamin A, and other micronutrients [The initial study found smaller percentage point changes in children’s milk consumption than the follow-on study but showed that mothers’ intervention exposure was associated with the frequency of ASF consumption [This study adds to the limited literature on SBCC interventions to engage fathers in child nutrition by providing evidence on the impacts of a multi-component intervention on child ASF consumption and fathers’ knowledge and support through quantitative data collected from fathers. To our knowledge, only one other study, in Nigeria, has used multiple channels to reach fathers on child feeding and measured changes in fathers’ knowledge and support [Health-related knowledge and awareness are considered prerequisites for behavior change [Social support from fathers for child feeding practices is often instrumental in ensuring that mothers are able to carry out optimal practices or that mothers and fathers work together to implement them [It is important for evaluations to report on participants’ intervention exposure to make the case that the intervention led to the observed outcomes; however, few other intervention studies have reported fathers’ intervention exposures. Fathers’ exposure to the intervention components in this study was quite high for all elements except megaphone blasts and was verified by monitoring data collected during implementation. A higher percentage of fathers in this study recalled receiving nutrition-related text messages than in studies in Senegal and Nigeria [Fathers in our study liked having role models (e.g., model fathers) whose practices they could emulate and who were trusted sources of information. This aligns with findings from a study in Kenya, which used peer educators to lead fathers’ groups [This study had several strengths and limitations. The strengths were use of formative research to design the SBCC intervention and close collaboration on design and implementation with national- and district-level government agencies. The main limitations were the lack of a control group, the possibility of social desirability bias in the survey and qualitative responses, and COVID-related disruptions. It was not possible to have a control group, because all households in the two districts that had a child in the appropriate age range and that were Girinka participants or Girinka-eligible had already been enrolled in the initial study; therefore, we chose a longitudinal pre/post design. The changes found in this study are likely attributable to the intervention, because no other programs targeting ASF messages to fathers were implemented in these areas. Mothers in FGDs reported hearing ASF messages during community meetings for women, which indicates sustainability of our initial study intervention but also suggests that the follow-on study may be at least partially detecting effects of the initial study targeted at mothers. All primary and secondary outcomes were based on self-report by fathers, which may be subject to bias. Knowledge and support questions were open-ended, which helps to limit response bias. The percentage of children reported to have consumed different ASFs varied widely by type of ASF, suggesting that fathers were being truthful. Self-reported intervention exposure data was corroborated by monitoring data collected during implementation. Our qualitative data asking about opinions on the intervention also may have been subject to social desirability bias. To counterbalance that possibility, we asked about and presented barriers to implementation and challenges with carrying out the recommendations. Given that not all children in the study consumed ASFs at endline, issues related to the cost and availability of ASFs remain and could not be addressed by a behavior change intervention alone.In conclusion, this study showed that a low-cost SBCC intervention that reached out to fathers improved child feeding practices, increased fathers’ knowledge of and support for child feeding, and increased joint decision-making by fathers and mothers about the use of home-produced foods. Our findings suggest that nutrition SBCC interventions specifically for fathers can be beneficial, but several gaps remain. More studies and programs that involve fathers should collect data from fathers, so that we can better understand changes in fathers’ knowledge and practices and how they related to nutrition outcomes. Work by Ambikapathi et al. [