Bringing about Behavior Change to Reduce Stunting Through Action-Oriented Support Group Negotiations

Introduction: Although Tanzania has made considerable progress in addressing undernutrition in children in recent years, the level of stunting remains a public health concern affecting 32% of children aged <5 years. Stunting impairs physical growth and mental development, affecting school performance in children and resulting in low productivity in adulthood.

Objective: The ASTUTE project, locally known as Mtoto Mwerevu, aimed to significantly reduce stunting in children aged <5 years in five Lake Zone regions of Northwestern Tanzania through behavior change. Project intervention and results: The project used community health workers (CHWs) and volunteers from civil society organizations (CSO) to negotiate for behavior change via community home visits and support groups, respectively focusing on maternal, infant, young child, and adolescent nutrition (MIYCAN), Water, Sanitation, and Hygiene (WASH), early childhood development (ECD), and male involvement. Unlike in-home visits where individual caregivers are taken through eight steps of negotiations by a CHW, negotiation for behavior change in a group setting is more action-oriented and involves fewer steps: 1) personalize the group: ask about health and nutrition issues that group members are facing as they related to stunting reduction; 2) discuss and brainstorm solutions: ask group members what new practices they can use to overcome the challenges identified; 3) commitment: group members teach-back practices they applied to ensure they are well understood, share the benefits of these practices, and encourage group members to commit and attempt new practices of their choosing. Group members mention aloud which stunting reduction practices they are committing to, and all other group members are asked what they can do to support the parents as they try the practices. This commitment is documented, and follow-up is conducted at the next support group meeting. Project results from baseline, midline, and endline have indicated significant improvements in dietary diversity and attendance at antenatal care (ANC) by mothers during the most recent pregnancy, breastfeeding exclusively for the first six months, and mothers' engagement with the child in the previous week.