Early childhood development intervention and timely initiation of complementary feeding among HIV exposed infants in Tanzania: a quasi-experimental study

Background Timely initiation of complementary feeding for HIV-exposed infants (HEI) is essential in improving the child’s health and for ensuring the child’s nutritional requirements are met. ECD interventions have been integrated to HIV programs as one of the approaches to improve complementary feeding practices among HEI. However, there is limited evidence regarding the contribution of Early Childhood Development (ECD) intervention on timely initiation of complementary feeding among HEI in Tanzania. Methods The study employed a post-test-only non-equivalent comparison-group quasi-experimental design. The study evaluation was conducted in 2025, with Mbeya and Tabora regions serving as the interventiongroup, and Shinyanga and Simiyu regions as the comparison group. Both project groups shared a common characteristic of being part of the Pact-led ACHIEVE project funded by the US government (2020–2026), while the intervention group received an additional ECD intervention. The study participants were 658 HEI aged 6–12 months from both the intervention and comparison groups. The outcome variable was the timely initiation of complementary feeding while The ECD intervention was the main explanatory variable of interest, and the associations were assessed using multivariable modified Poisson regression with robust standard errors. Results The results from multivariable analysis revealed that the ECD intervention was significantly associated with a 10.9% higher prevalence of timely initiation of complementary feeding among HEI (aPR = 1.109, 95% CI: 1.033–1.191, p = 0.004). HEI whose male caregivers engaged in childcare had 37.6% higher prevalence of timely initiation of complementary feeding than those whose male caregivers were not (aPR = 1.376, 95% CI: 1.239–1.529, p < 0.001). HEI residing in urban areas had 12.0% lower prevalence of timely initiation of complementary feeding than their rural peers (aPR = 0.880, 95% CI: 0.803–964, p = 0.006). In addition, HEI whose caregivers had primary education had 8.0% lower prevalence of timely initiation of complementary feeding than those whose caregivers had never attended school (aPR = 0.920, 95% CI: 0.861–0.984, p = 0.015). Conclusion The positive association between ECD intervention and higher prevalence ratio of timely initiation of complementary feeding among HEI may be attributed by improved caregiver nutrition knowledge and practices, male partner involvement resulted from routinely nutrition counseling sessions during paid home visits by CCWs. This finding suggests that expanding the coverage of the ECD intervention to reach more HEI, particularly those at higher risk, such as HEI living in urban areas, may help address existing barriers and contribute to improved child nutrition and overall development.