Impact of a diet diversification and health and nutrition counseling program in Madagascar

Background: Due to lack of resources, especially for mothers and children, Madagascar has high levels of malnutrition. Health promotion and education have shown to be effective in increasing health status in limited-resource areas. This study piloted a tailored, four-week health and nutrition counseling program to improve diet diversity and health promoting practices. Methods: Twenty child caregivers were recruited from Andasibe, Madagascar, using snowball sampling, and were provided weekly individualized health counseling with education materials by the research team. Diet, health knowledge, and health behaviors were assessed using a quasi-experimental one-group pre/post-test design. Body mass index, mid-upper arm circumference measurements, and Raman spectroscopy technology assessed nutritional status. Data were analyzed using descriptive statistics and paired sample t-tests to determine changes. Results: All caregivers were female. More caregivers were within normal limits for Body Mass Index (40%) than underweight or overweight, and most were within normal limits for mid-upper-arm circumference (75%). Significant increases (p≤0.01) were found in caregiver consumption of vitamin A-rich foods, and using treated water to wash fruits and vegetables, though significant increases were not found for children. The majority (80%) increased diet diversity. Participants increased their knowledge of nutrition and non-nutritious foods. Conclusions: Results suggest an individualized approach to health promotion in a limited-resource area can improve diet diversity, knowledge and health practices. Opportunities for further education and research include increasing knowledge of nutrient dense foods, expanding food choice beyond carbohydrate-rich foods, diet diversity importance, and sustaining education efforts beyond project implementation. Strategies highlighted in this research can inform others working in limited-resource areas.