author(s)
Samuel Ikendi, Francis Owusu and Dorothy Masinde

abstract
Achieving behavioral changes in essential maternal health and feeding practices requires continuous nutrition and health education. Our case study focused on the nutrition and infant feeding education programs of the Center for Sustainable Rural Livelihoods based at Iowa State University in the United States, which implemented the programs in Uganda through the Iowa State University Uganda Program based in Kamuli district. The program enhances the knowledge of communities through nutrition education to understand the root cause of malnutrition and how using food can manage the problem. Additionally, through reproductive and maternal health education, the program enhances community knowledge to influence behavioral change in related practices for the well-being of the mothers and their children. We compared the changes in maternal and infant feeding practices between trained and non-trained households. We surveyed 454 households, of whom 54.6% participated in nutrition and infant feeding education programs. All participations in training were high in the third quartile. However, most households participated in training on complementary feeding, balanced diet, breastfeeding, but low in malnutrition clinical signs and gender-based violence. We also assessed the mothers’ antenatal clinic visit practices on the last four children born. Trained mothers of the youngest child, for instance, were 65.1% associated with attending at least four antenatal clinic visits, than 45.6% of the non-trained who attended at least four antenatal clinic visits. There was a positive behavioral change toward attending at least four antenatal clinic visits among trained mothers, but there was a negative trend among non-trained mothers. In the birthplace, we consider hospitals and health centers as safe places; homebirth with a nurse and traditional birth attenders as risky; and homebirth with relatives and friends as extremely risky. Overall, most mothers (83.0%) went to safe places; however, mothers consistently gave birth at home as the number of children increased. On exclusive breastfeeding for the first six months, non-trained mothers significantly (86.0%) breastfed than the trained mothers (76.9%). Most importantly, there was a positive behavioral change trend towards exclusive breastfeeding among trained mothers who were in the malnutrition rehabilitation programs. Household factors that influenced participation in the training included age, years lived in the community, membership of social groups, spatial location, household size, and mothers’ education. We recommend more partnerships in monitoring the mothers’ practices between program community extensionists and the government village health trainers. The growing vice of birthing from home denies the mothers’ postnatal care valuable for their health in such limited resource communities. More mobilization for training participants is needed for the community to tap into this knowledge resource offered by the programs in partnership with the government and other stakeholders.