# The impact of nutrition-specific interventions on nutritional knowledge, dietary intake, and anemia among lactating mothers in Bukavu, Democratic Republic of the Congo – a randomized controlled trial

## TL;DR

This study in the DRC found that nutrition education improved lactating mothers' knowledge and feeding practices but did not significantly affect anemia.

## Contribution

The study provides evidence on the effectiveness of nutrition-specific interventions in a politically unstable, malnourished region.

## Key findings

- Nutrition education significantly improved maternal nutritional knowledge scores.
- Nutrition education positively influenced complementary feeding practices.
- No significant improvement in maternal hemoglobin levels was observed.

## Abstract

Amelioration of maternal nutrition is crucial in the Democratic Republic of the Congo (DRC), that experiences political instability and malnutrition. This study aimed to evaluate the impact of nutrition-specific interventions on nutritional knowledge, dietary practices, and hemoglobin (Hb) status among lactating mothers in the Bukavu region, DRC.

A randomized, controlled trial was conducted with 416 mother–infant pairs from 3–6 to 6–9 months postpartum. The mothers were classified according to their mid-upper-arm circumference (MUAC) and subsequently assigned to the following intervention and control groups by block randomization: low MUAC–nutrition education, low MUAC–lipid-based nutrient supplements, low MUAC–control; normal MUAC–control; high MUAC–nutrition education, high MUAC–control. The pre- and post-intervention assessments included questionnaires on nutritional knowledge and practice to calculate scores (range 0–1); 24 h dietary recalls to calculate the Dietary Diversity Score (DDS, range 0–10); and measurement of maternal Hb. Changes of these parameters from pre- to post-intervention were analyzed by linear mixed models.

The change of total knowledge score from pre- to post-intervention was significantly positively affected by reception of nutrition education with a model-based mean difference of 0.161 between mothers with nutrition education compared to those without (p = 0.000). The change in DDS was not affected, but there was a positive impact of nutrition education on the modification of complementary feeding practices (OR 2.930, p = 0.030). Change in maternal Hb was not different between the intervention and control groups with higher increases among mothers with anemia compared to all mothers.

Nutrition education can positively influence knowledge and potentially complementary feeding, while further measures may be required for beneficial effects on anemia.

The study was registered prospectively at the German Clinical Trials Register (DRKS; DRKS-ID DRKS00012842) on November 27, 2017.

The online version contains supplementary material available at 10.1186/s40795-025-01231-x.