Pictorial calendar for adherence to complementary feeding (PiC-Feed)

Education Session: Control and Intervention Arms The education session was conducted by the Research Assistant (RA), which was about an hour in duration. We adapted behavioural recommendations from previous successful intervention in this population, the WASH Benefits Bangladesh trial and UNICEF’s complementary feeding guidelines. The nutrition education messages were delivered at households using illustrative flip charts, in one face to face meeting with both parents. Messages emphasized the following: • Continued breastfeeding until two years of age • Food groups • Balanced diet • Introduction to locally available nutritious and low-cost foods • Amount and frequency of complementary feeding • Safe water, and • Handwashing with soap before feeding Pictorial calendar: Intervention Arm Following the one hour nutrition education session mothers were supplied with a pictorial calendar kit. It took another 15-30 minutes to explain the calendar to the mothers. The calendar itself had two parts: first part was a usual calendar. The second part of it was the pictures of different food groups, which we added to the calendar. The second component of this kit was the colored dots. There were four colored stickers that the mothers had to add to the calendar every day. The colors represented food groups that were illustrated in the calendar: • Yellow=energy yielding foods (rice, bread, oil, potato) • Red=body building foods (fish, meat, egg, milk, lentil) • Green=protective foods and (fruits and vegetables) • Blue=breastfeeding The RA described to the mothers how and when to fill out the calendar. The RA made sure that the mothers felt confident about filling out the calendar. Mothers were asked to start filling out the calendar in the morning. One particular day in the pictorial calendar started in the morning and ended up on the next morning. Mothers were encouraged to check for completeness of the calendar next morning before starting a new day. The RA made an informal visit to the households within a day or two after the household meeting to check if they were comfortable filling out the calendar. The mothers were to fill out the calendar everyday for 4 weeks.