(P24-060-24) Comparison of Methods to Assess Adherence to Infant and Young Child Feeding Practices and Provision of Low-Aflatoxin Porridge Flours in a Community-Based Intervention Trial

Objectives: To broaden the evidence about the selection and utility of adherence measures in varying contexts, we describe the level adherence to the Mycotoxin Mitigation Trial (MMT) randomized intervention using caregiver-reported survey questions and compare inferences of adherence between surveys and interactive 24-hour dietary recalls based on our program theory.

Methods: The MMT was a two-arm cluster-randomized trial conducted in 52 health facilities (clusters) in central Tanzania. Surveys were conducted with all trial participants at three time points and dietary recalls conducted in a cohort at 12 mo. The 12 mo survey was conducted with 2,112 caregivers and the 18 mo survey with 2,527 caregivers. A cohort of participants (n=282, 20 clusters) was selected for dietary recalls, balanced by arm.

Results: Reported feeding of blended porridge flours, whether MMT-provided or own-sourced, was high at 12 and 18 mo, between 73-95%, with only slight differences between the surveys and recalls. Continuation of breastfeeding, feeding frequency, and dietary diversity resulted in similar inferences between the two methods. Only the amount of porridge fed the previous day differed statistically by method, with higher amounts reported in the recalls compared to the survey.

Conclusions: Detailed analysis of reported behaviors, based on the MMT program theory, supports high adherence to the recommended trial behaviors. Survey data and 24-hour dietary recalls were convergent for almost all indicators, strengthening the trial’s conclusions and allowing for either method to be selected for similar research.

Funding Sources: This research was funded by the Bill & Melinda Gates Foundation.