Effect of nutrition education delivered through Gada system leaders on the dietary diversity of children aged 6 to 23 months in West Ethiopia: a cluster-randomized controlled trial

Poor dietary diversity (DD) is a major contributor to undernutrition among infants and young children in Ethiopia. However, evidence is limited on the effectiveness of culturally appropriate, theory-based nutrition education interventions for improving complementary feeding practices. This study aimed to assess the effect of nutrition education delivered through Gada system leaders on dietary diversity among children aged 6 to 23 months in rural areas of East Wollega Zone, Ethiopia. A community-based, two-arm, parallel cluster-randomized controlled trial was conducted among 566 randomized mother–child pairs (283 per arm), of whom 520 (258 intervention and 262 control) were analyzed. A multistage cluster sampling technique was employed, followed by simple random sampling to select the study participants. The intervention arm received six nutrition education sessions while the control arm received standard care. Data were collected using a pre-tested, interviewer-administered, & structured questionnaire. Dietary diversity (DD) was assessed using a 24-hour dietary recall and categorized according to the World Health Organization minimum DD indicators. Data were analyzed using generalized estimating equations (GEE) binary logistic regression model to account for clustering and repeated measurements. Adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) were used to estimate the strength of the effect of intervention on Minimum dietary diversity. After the intervention, minimum DD was achieved by 29.06% of children in the intervention arm versus 13.35% in the control arm, a crude difference of 15.71% points. The difference-in-differences (DiD) analysis showed a 10.45%-point greater improvement in minimum DD in the intervention arm. After adjusting the background characteristics, the intervention-by-time interaction (AOR = 1.52, 95% CI: 1.01, 2.29), maternal exposure to infant and young child feeding information (AOR = 2.18, 95% CI: 1.29, 3.70), and maternal occupation as a housewife (AOR = 3.22, 95% CI: 1.39, 7.47) were significantly associated with improved minimum DD. Nutrition education delivered through Gada system leaders significantly improved dietary diversity among children aged 6 to 23 months. The findings demonstrate the potential of integrating culturally trusted traditional leadership structures with theory-based behaviour change approaches to strengthen complementary feeding practices in rural communities. Nutrition policies and programmes should consider systematically engaging Gada leaders and other trusted community structures as complementary platforms for delivering contextually appropriate nutrition education and behaviour change interventions. Institutionalizing such community-led approaches within routine nutrition and primary healthcare programs could improve mothers’ access to reliable child-feeding information and contribute to better dietary diversity and prevention of child undernutrition in rural Ethiopia. The trial was registered on ClinicalTrials.gov (NCT05503654), prospectively registered (first posted) on 17 August 2022.