A Comparative Effectiveness Trial of Three Complementary Feeding Interventions on Child Growth and Neurodevelopment in Rural Kebbi State

The optimal combination of food-based, behaviour change, and supply-side interventions for improving complementary feeding practices and child outcomes in resource-poor settings remains an open empirical question, particularly in North West Nigeria where both undernutrition and neurodevelopmental delays are prevalent. This study compares the effectiveness of three complementary feeding intervention arms on child growth and neurodevelopmental outcomes among children aged 6 to 24 months in Birnin Kebbi and Argungu local government areas of Kebbi State. A four-arm cluster randomised controlled trial randomised 48 village clusters to: enhanced complementary feeding counselling only, counselling plus local food vouchers, counselling plus small-quantity lipid-based nutrient supplement distribution, or standard care control. Eight hundred and forty children were enrolled across clusters and followed for twelve months with assessments at baseline, six months, and twelve months. Primary outcomes included change in length-for-age z-score and weight-for-height z-score. Secondary outcomes included dietary diversity scores, neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development adapted for Northern Nigerian populations, haemoglobin, serum retinol, and caregiver knowledge scores. Intraclass correlation coefficients informed cluster-level adjustment in all analyses. Process evaluation using the Medical Research Council framework documented intervention fidelity, reach, and mechanism of change across arms. This trial will generate comparative effectiveness evidence to guide selection of complementary feeding intervention packages in rural North West Nigerian settings. Keywords: complementary feeding, cluster randomised trial, child growth, neurodevelopment, Kebbi State.