Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under


Dachi Arikpo1, Ededet Sewanu Edet2, Moriam T Chibuzor1, Friday Odey3 , Deborah M Caldwell4

1 Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
2 Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
3 Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
4 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

Arikpo  D, Edet  ES, Chibuzor  MT, Odey  F, Caldwell  DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD011768. DOI: 10.1002/14651858.CD011768.pub2

Access the full text article here: DOI 10.1002/14651858.CD011768.pub2/full


Complementary feeding is the period when an infant moves from taking only breast milk or breast‐milk substitutes (such as infant formula) to family food. It is a critical period in the life of an infant. Inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. This is because inappropriate complementary feeding practices, such as introduction of semi‐solid foods too early (before six months of age), poor hygiene or giving foods that do not contain adequate nutrients, are all major causes of illness. Such illnesses include malnutrition, diarrhoea, poor growth, infections and poor mental development of children. Education has been proposed as an effective means of improving complementary feeding practices.

Review question

Does education improve complementary feeding practices of caregivers of infants as well as the health and growth of the infants?

Study characteristics

We searched for randomised controlled trials (a type of experiment in which people are randomly allocated to one or more treatment groups) up until November 2017. The search identified 23 studies involving a total of 11,170 caregivers and their children. The ages of the children ranged from birth to 24 months. The caregivers received educational interventions alone while the control group received no intervention, usual care or any other non‐educational intervention. The educational methods included printed materials such as leaflets, counselling, teaching sessions, peer support, videos and practical demonstrations. Generally, the education messages were focused on the introduction of semi‐solid foods at the appropriate age, the types and amount of complementary foods to be fed to infants, and hygiene.

Key results

Education reduced the number of caregivers that introduced semi‐solid foods to their infants before six months of age by up to 12% (moderate‐quality evidence). Hygiene practices of caregivers who received education also showed some improvement compared to those that did not (moderate‐quality evidence). In studies conducted in the community, education increased the duration of exclusive breastfeeding, but not in studies conducted in health facilities. There was no convincing evidence of an effect of education on the growth of children (low to very low‐quality evidence). We could not combine the results from different studies for diarrhoea, knowledge of caregivers and adequacy of complementary food. However, from the individual reports of the study authors, education led to a reduction in diarrhoea and an improvement in the knowledge of caregivers. It also led to improvement in the quality and quantity of complementary foods fed to infants.

Overall, we found evidence that education improves complementary feeding practices.