The impact of nutrition-specific interventions on nutritional knowledge, dietary intake, and anemia among lactating mothers in Bukavu, Democratic Republic of the Congo – a randomized controlled trial

BACKGROUND: Amelioration of maternal nutrition is crucial in the Democratic Republic of the Congo (DRC), that experiences political instability and malnutrition. This study aimed to evaluate the impact of nutrition-specific interventions on nutritional knowledge, dietary practices, and hemoglobin (Hb) status among lactating mothers in the Bukavu region, DRC. METHODS: A randomized, controlled trial was conducted with 416 mother-infant pairs from 3-6 to 6-9 months postpartum. The mothers were classified according to their mid-upper-arm circumference (MUAC) and subsequently assigned to the following intervention and control groups by block randomization: low MUAC-nutrition education, low MUAC-lipid-based nutrient supplements, low MUAC-control; normal MUAC-control; high MUAC-nutrition education, high MUAC-control. The pre- and post-intervention assessments included questionnaires on nutritional knowledge and practice to calculate scores (range 0-1); 24 h dietary recalls to calculate the Dietary Diversity Score (DDS, range 0-10); and measurement of maternal Hb. Changes of these parameters from pre- to post-intervention were analyzed by linear mixed models. RESULTS: The change of total knowledge score from pre- to post-intervention was significantly positively affected by reception of nutrition education with a model-based mean difference of 0.161 between mothers with nutrition education compared to those without (p = 0.000). The change in DDS was not affected, but there was a positive impact of nutrition education on the modification of complementary feeding practices (OR 2.930, p = 0.030). Change in maternal Hb was not different between the intervention and control groups with higher increases among mothers with anemia compared to all mothers. CONCLUSION: Nutrition education can positively influence knowledge and potentially complementary feeding, while further measures may be required for beneficial effects on anemia. TRIAL REGISTRATION: The study was registered prospectively at the German Clinical Trials Register (DRKS; DRKS-ID DRKS00012842) on November 27, 2017.