Effect of nutrition counseling on complementary feeding practices among mothers with children aged 6–23 months in West Gojjam Zone, Northwest Ethiopia: A cluster-randomized controlled trial

BACKGROUND: Appropriate complementary feeding is essential for children's growth and cognitive development. However, these practices remain inadequate in the study area. Therefore, this study aimed to evaluate the effect of nutrition counseling on complementary feeding practices among mothers with children aged 6-23 months in West Gojjam Zone, Northwest Ethiopia. METHODS: A two-arm, parallel, cluster-randomized controlled trial was conducted from June 2023 to December 2024 in rural districts of West Gojjam Zone. Thirty clusters (15 per arm) were assigned to either an intervention group (n = 401), which received Health Belief Model-based nutrition counseling by Women's Development Army leaders, or to a control group (n = 401), which received routine education. The intervention was delivered monthly for nine months from infant age 6-8 months. The primary outcome was appropriate complementary feeding practices. Secondary outcomes included minimum dietary diversity, meal frequency, acceptable diet, and egg/flesh food consumption. Data were collected via interviewer-administered questionnaires. The intervention effect was analyzed using Generalized Estimating Equations with adjustment for potential confounders. Statistical significance was set at p < 0.05. RESULTS: The difference-in-differences in appropriate complementary feeding practices between groups was 13.2 percentage points. After adjustment, mothers in the intervention group were nearly 2.5 times more likely to practice appropriate complementary feeding than controls [AOR = 2.49, 95% CI: (1.40, 4.42)]. Children of counseled mothers were also more likely to achieve minimum dietary diversity [AOR = 1.75, 95% CI: (1.04, 2.93)], minimum meal frequency [AOR = 1.62, 95% CI: (1.01, 2.61)], and minimum acceptable diet [AOR = 2.13, 95% CI: (1.26, 3.59)] compared with controls. CONCLUSION: Health Belief Model-based nutrition counseling was positively associated with improvements in appropriate complementary feeding practices, minimum dietary diversity, meal frequency, and acceptable diet. Integrating such counseling into routine maternal and child health services may strengthen child nutrition programs in similar rural settings. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05871346).