Home Visits Linked to Better Timing of First Foods for HIV-Exposed Babies in Tanzania

A baby's first foods come with plenty of questions, and families managing HIV may face extra worries about feeding, health and finding advice they can trust. Research from Tanzania suggests that regular support at home could help caregivers navigate this stage, with more infants introduced to complementary foods on time in communities receiving additional early childhood development services.

The study, "Early childhood development intervention and timely initiation of complementary feeding among HIV exposed infants in Tanzania: a quasi-experimental study," published in Frontiers in Nutrition, examined feeding practices among 658 infants. Ignas Lukanga and colleagues found that added family support and male caregivers' involvement in childcare were associated with better feeding timing, offering useful lessons for programmes supporting families affected by HIV.

First foods involve more than choosing what goes on the spoon

Complementary feeding means giving a baby food alongside breast milk or formula as their nutritional needs increase. The paper recommends starting at six months because breast milk alone can no longer provide all the nutrients a growing baby needs.

The researchers counted babies who started these foods between six and eight months as starting "on time." They used this age range to measure their results; it does not mean parents should wait until eight months to introduce food. The babies in the study were born to or breastfed by women living with HIV, which means they had been exposed to the virus. Being exposed to HIV does not mean a baby has HIV.

Families may worry about passing HIV to their babies or being judged by others. Cultural beliefs and difficulty getting clear feeding advice can influence their decisions, and busy health services may leave parents with little time to ask questions.

The study looked at how family life affects a child's care, including support at home, parents' work responsibilities and access to community services. Understanding these everyday challenges can help services give families more useful feeding support.

Bringing practical support into the family home

The study took place in 2025 and included 658 babies aged six to twelve months from four regions in Tanzania. Researchers compared 301 babies in Mbeya and Tabora who received extra support with 357 babies in Shinyanga and Simiyu who received the usual programme services.

All families were part of Pact's ACHIEVE project, a US government-funded programme supporting children and families affected by HIV. Families in Mbeya and Tabora received extra help through a child development programme funded by the Conrad N. Hilton Foundation for 2023–2026.

Community workers received ten days of training before visiting families at home each month. They helped caregivers with breastfeeding, preparing food, supporting children's learning, responding to their needs and keeping them safe, and regularly checked how well the children were nourished. Home visits gave parents and other caregivers time to ask questions and discuss feeding challenges in their daily lives. Workers used practical teaching materials and kept monthly records, with local child development officers supervising their work.

Researchers gathered information through interviews, observations and programme records. About three in four babies lived in rural areas, and nearly 98% of their main caregivers were women.

Better feeding timing, with a strong link to men's involvement

Across the full sample, 547 infants, or 83.13%, started complementary feeding within the study's six-to-eight-month window. The proportion reached 87.38% in the intervention group and 79.55% in the comparison group, a difference of about eight percentage points.

After accounting for measured background characteristics, participation in the additional programme was associated with a 10.9% higher prevalence of timely feeding. The association was statistically significant, with an adjusted prevalence ratio of 1.109 and a 95% confidence interval of 1.033–1.191.

Male caregivers' participation in childcare showed an especially strong association. Timely feeding was recorded for 90.34% of infants whose male caregivers were involved, compared with 65.62% of infants whose male caregivers were not involved. The adjusted analysis found a 37.6% higher prevalence of timely feeding among infants with involved male caregivers.

The authors suggest that sharing household responsibilities could give mothers more time for childcare and encourage joint decisions about food. These explanations are plausible pathways rather than mechanisms directly established by the study.

Location made a difference. Urban infants had a 12% lower adjusted prevalence of timely feeding than rural infants, with unadjusted proportions of approximately 76% and 85%, respectively. The researchers propose that demanding work schedules, varied social settings and concerns about disclosing HIV status could make participation harder for some urban families.

Caregiver education produced an unexpected finding: infants whose caregivers had primary education had an 8% lower adjusted prevalence of timely feeding than those whose caregivers had never attended school. The secondary-education group recorded a lower unadjusted proportion, though its adjusted association was not statistically significant.

What these findings mean for family support

The authors recommend expanding access, paying particular attention to urban families and encouraging male caregivers to participate in childcare. Families were not randomly assigned to receive the additional programme, and the evaluation compared outcomes after implementation without a baseline feeding comparison. Differences between the regions could have influenced the results.

Statistical adjustments accounted for several measured characteristics, but information on potentially important factors, including socioeconomic status, was unavailable. Findings from four regions and families already enrolled in ACHIEVE may not apply to every community. The outcome assessed was the timing of complementary feeding, so these results do not establish improvements in dietary quality, growth, development or HIV-related health outcomes.