Background

Nutrition education is an effective and efficient intervention strategy for behaviors change on maternal and child nutrition in order to reduce the risk of malnutrition in rural communities of low- and middle-income countries like Ethiopia. Improving nutrition status and dietary diversity among pregnant women is the initial step for breaking the intergeneration effect of malnutrition. Little was known on the effect of nutritional education on dietary diversity and nutrition status of pregnant women

Objectives

To measure the effect of nutritional education intervention on dietary diversity, and nutrition status of pregnant women in rural kebeles of Dessie.

Methods

Cluster randomized controlled trial study design mixed with qualitative method was used from April- Sept 2019 G.C to conduct the study on randomly selected 113pregnant women from four rural kebeles with random allocation of   60 intervention and 53 control groups. Nutrition education intervention using HBM was given every two weeks for three months to the intervention group. Data was collected using standard questionnaire from Food and Nutrition Technical Assistant (FANTA) tool and anthropometric measurements with mid upper arm circumference (MUAC) before and after intervention. Open Data Kit (ODK) mobile application was used to collect the data and exported to STATA version 14 for analysis. Composite variables were aggregated using PCA, data were analyzed using independent and paired sample t-tests and general linear model of repeated measures using ANOVA was determined to compare the real difference on intervention and control group before and after intervention period. Mean difference and 95% CI of mean difference and P < 0.05 was used   as measure of statistical significance. Qualitative data was analyzed by NVivo software and thematic content analysis was used.

Result

The result showed a significant improvement in dietary diversity score [-0.98; 95% CI= -1.46- -0.50], nutrition status [-1.31; 95% CI= -2.15- -0.47], WASH index [-1.22; 95% CI= -1.60 - -0.86] and constructs of HBM; perceived severity [-0.56; 95% CI= -0.92- -0.20], perceived barrier [-1.14;95% CI= -1.44 - -0.83]   and cue to action [-0.61 ;95% CI= -0.97 - -0.26] in the intervention group than the control group.

Conclusion and recommendation

Nutritional education intervention using HBM has significant effect to improve dietary diversity, nutrition status, WASH practice and behavior change of pregnant women. Nutritional education should be started in early pregnancy and continues to the first 1000 days of life and integrated with all ANC visit and encourage to use HBM to change behavior on the feeding practice and to improve the nutritional status of pregnant women for better birth out come and productive generation.

Key words: Cluster Randomized Controlled trial, Dietary diversity, Health Belief Model, nutrition education, nutritional status