A balanced diet is critical for preschool aged children; meals must be sufficiently diverse to provide the essential nutrients required for rapid physical and cognitive development. Because dietary habits established in early childhood often persist into adulthood, prioritizing this age group is a cost-effective investment in long-term national health and productivity. However, the National Food Consumption Survey in Ethiopia indicates a significant gap in dietary quality, with only 20% of households across all age groups consuming five or more food groups. Implementing multi-component nutrition interventions is essential, as these strategies significantly influence both the eating habits and dietary preferences of preschool children.
Background and Rationale Dietary habits acquired during early childhood frequently persist through adolescence and into young adulthood. Children develop preferences for foods through repeated exposure and are influenced by parental modeling, rewards, and shared mealtime enjoyments. Beyond individual factors, child nutrition is shaped by a complex interplay of parental preferences, parenting styles, food security, and environmental influences such as media and childcare policies. In the school environment, key drivers include nutrition policies, formal curricula, and the knowledge and practices of staff. Study Aim and Design This study aims to evaluate the impact of a multi-component nutrition education intervention on the diet quality and dietary preferences of kindergarten students in the Jimma Zone, Southwest Ethiopia. A mixed-methods approach will be employed, utilizing a cluster randomized controlled trial (cRCT) and concurrent cross-sectional design. Methodology A total of 451 students from ten clusters (schools) will be enrolled. These clusters will be randomly assigned to either the intervention or control group (5 schools each), with approximately 45 students selected per cluster. The intervention includes weekly nutrition education for parents delivered via leaflets and mHealth (vie Telegram) and school based nutrition information for students led by trained female health care providers/nutritionists. Outcome Measures \& analysis The primary outcomes are mean child diet quality (DDS) and dietary preferences, assessed at baseline and endline. Data will be managed via double entry in EpiData and analyzed using STATA version 15.1. Following an intention-to-treat (ITT) principle, a Difference-in-Differences (DiD) estimator will be used to compare the change in mean scores between groups over the 6-month intervention period. To account for the clustered nature of the data and potential residual confounding, Generalized Estimating Equations (GEE) and mixed-effects multilevel linear regression models will be applied.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
451
Parent-Focused Component: The intervention group will receive weekly nutrition education delivered through a multi-modal approach involving mHealth (Telegram) and printed materials. Educational content is derived from the Ethiopian Food-Based Dietary Guidelines and evidence-based literature, culturally tailored to the local context. Printed leaflets will be provided in both Amharic and Afan Oromo and will incorporate pictorial aids to ensure accessibility for parents and caregivers with limited literacy levels. Child-Focused Component: Simultaneously, students will participate in bi-weekly nutrition education sessions led by trained nutritionists or health professionals. These sessions are designed based on WHO age-appropriate nutrition education recommendations and will be conducted throughout the duration of the intervention period.
Jimma University
Jimma, Oromiya, Ethiopia
RECRUITINGMean School-Lunch Dietary Diversity Score (mDDS)
The nutritional quality of home-packed school meals (including snacks and lunches) will be assessed using a structured parent reported lunchbox inventory over two non-consecutive school days. The score is calculated based on the presence of 9 distinct food groups adapted from the FAO(Food and Agriculture Organization)/WHO(World Health Organization) dietary diversity indicators: Starchy staples (grains, roots, tubers) Legumes and nuts Dairy products Flesh foods (meat, poultry, fish) Eggs Vitamin A-rich fruits and vegetables Dark green leafy vegetables Other vegetables Other fruits. For each observation day, a score is calculated (Range: 0-9). The final primary outcome is the mean score across the two data collection days. A higher score represents a more diverse and higher-quality school meal.
Time frame: Baseline and 6 months post-intervention
Child's Healthy Dietary Preference Score
Children's preferences for healthy versus unhealthy foods will be assessed using a pictorial tool adapted for the local Ethiopian context. Children are presented with 10 pairs of standardized images (one nutrient-dense item and one energy-dense/processed item). For each pair, the child selects their preferred item. A score of 1 is given for each healthy choice. The total score ranges from 0 (lowest preference) to 10 (highest preference). The outcome is the change in the mean score from baseline to endline. A higher score indicates a stronger preference for healthy dietary options.
Time frame: Baseline and 6 months post-intervention.
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