Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh
**Background**: Complementary feeding (CF) contributes to child growth and development, but few CF programs are delivered at scale. Alive & Thrive addressed this in Bangladesh through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM). **Objective:** The ob...
| Autores principales: | , , , , , , , , , , |
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| Formato: | Journal Article |
| Lenguaje: | Inglés |
| Publicado: |
Elsevier
2016
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| Materias: | |
| Acceso en línea: | https://hdl.handle.net/10568/146492 |
| _version_ | 1855543691773476864 |
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| author | Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Sanghvi, Tina Baker, Jean Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul |
| author_browse | Afsana, Kaosar Baker, Jean Frongillo, Edward A. Haque, Raisul Khaled, Adiba Menon, Purnima Nguyen, Phuong Hong Rawat, Rahul Ruel, Marie T. Saha, Kuntal K. Sanghvi, Tina |
| author_facet | Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Sanghvi, Tina Baker, Jean Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul |
| author_sort | Menon, Purnima |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | **Background**: Complementary feeding (CF) contributes to child growth and development, but few CF programs are delivered at scale. Alive & Thrive addressed this in Bangladesh through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM).
**Objective:** The objective was to evaluate the impact of providing IPC + MM + CM (intensive) compared with standard nutrition counseling + less intensive MM + CM (nonintensive) on CF practices and anthropometric measurements.
**Methods:** We used a cluster-randomized, nonblinded evaluation with cross-sectional surveys [*n* = ∼600 and 1090 children 6–23.9 mo and 24–47.9 mo/group, respectively, at baseline (2010) and *n* = ∼500 and 1100 children of the same age, respectively, at endline (2014)]. We derived difference-in-difference impact estimates (DDEs), adjusting for geographic clustering, infant age, sex, differences in baseline characteristics, and differential change in characteristics over time.
**Results:** Groups were similar at baseline. CF improvements were significantly greater in the intensive than in the nonintensive group [DDEs: 16.3, 14.7, 22.0, and 24.6 percentage points (pp) for minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich foods, respectively]. In the intensive group, CF practices were high: 50.4% for minimum acceptable diet, 63.8% for minimum diet diversity, 75.1% for minimum meal frequency, and 78.5% for consumption of iron-rich foods. Timely introduction of foods improved. Significant, nondifferential stunting declines occurred in intensive (6.2 pp) and nonintensive (5.2 pp) groups in children 24–47.9 mo.
**Conclusions:** The intensive program substantially improved CF practices compared with the nonintensive program. Large-scale program delivery was feasible and, with the use of multiple platforms, reached 1.7 million households. Nondifferential impacts on stunting were likely due to rapid positive secular trends in Bangladesh. Accelerating linear growth further could require accompanying interventions. This study establishes proof of concept for large-scale behavior change interventions to improve child feeding. This trial was registered at [clinicaltrials.gov](https://clinicaltrials.gov) as NCT01678716. |
| format | Journal Article |
| id | CGSpace146492 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2016 |
| publishDateRange | 2016 |
| publishDateSort | 2016 |
| publisher | Elsevier |
| publisherStr | Elsevier |
| record_format | dspace |
| spelling | CGSpace1464922025-04-03T21:29:33Z Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Sanghvi, Tina Baker, Jean Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul stunting evaluation malnutrition child feeding children feeding child undernutrition experimental design **Background**: Complementary feeding (CF) contributes to child growth and development, but few CF programs are delivered at scale. Alive & Thrive addressed this in Bangladesh through intensified interpersonal counseling (IPC), mass media (MM), and community mobilization (CM). **Objective:** The objective was to evaluate the impact of providing IPC + MM + CM (intensive) compared with standard nutrition counseling + less intensive MM + CM (nonintensive) on CF practices and anthropometric measurements. **Methods:** We used a cluster-randomized, nonblinded evaluation with cross-sectional surveys [*n* = ∼600 and 1090 children 6–23.9 mo and 24–47.9 mo/group, respectively, at baseline (2010) and *n* = ∼500 and 1100 children of the same age, respectively, at endline (2014)]. We derived difference-in-difference impact estimates (DDEs), adjusting for geographic clustering, infant age, sex, differences in baseline characteristics, and differential change in characteristics over time. **Results:** Groups were similar at baseline. CF improvements were significantly greater in the intensive than in the nonintensive group [DDEs: 16.3, 14.7, 22.0, and 24.6 percentage points (pp) for minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich foods, respectively]. In the intensive group, CF practices were high: 50.4% for minimum acceptable diet, 63.8% for minimum diet diversity, 75.1% for minimum meal frequency, and 78.5% for consumption of iron-rich foods. Timely introduction of foods improved. Significant, nondifferential stunting declines occurred in intensive (6.2 pp) and nonintensive (5.2 pp) groups in children 24–47.9 mo. **Conclusions:** The intensive program substantially improved CF practices compared with the nonintensive program. Large-scale program delivery was feasible and, with the use of multiple platforms, reached 1.7 million households. Nondifferential impacts on stunting were likely due to rapid positive secular trends in Bangladesh. Accelerating linear growth further could require accompanying interventions. This study establishes proof of concept for large-scale behavior change interventions to improve child feeding. This trial was registered at [clinicaltrials.gov](https://clinicaltrials.gov) as NCT01678716. 2016-09-09 2024-06-21T09:07:15Z 2024-06-21T09:07:15Z Journal Article https://hdl.handle.net/10568/146492 en Open Access Elsevier Menon, Purnima; Nguyen, Phuong Hong; Saha, Kuntal K.; Khaled, Adiba; Sanghvi, Tina; Baker, Jean; Afsana, Kaosar; Haque, Raisul; Frongillo, Edward A.; Ruel, Marie T.; and Rawat, Rahul. Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh. Journal of Nutrition 146(10): 2075 - 2084. https://doi.org/10.3945/jn.116.232314 |
| spellingShingle | stunting evaluation malnutrition child feeding children feeding child undernutrition experimental design Menon, Purnima Nguyen, Phuong Hong Saha, Kuntal K. Khaled, Adiba Sanghvi, Tina Baker, Jean Afsana, Kaosar Haque, Raisul Frongillo, Edward A. Ruel, Marie T. Rawat, Rahul Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh |
| title | Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh |
| title_full | Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh |
| title_fullStr | Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh |
| title_full_unstemmed | Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh |
| title_short | Combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth: Results of a cluster-randomized program evaluation in Bangladesh |
| title_sort | combining intensive counseling by frontline workers with a nationwide mass media campaign has large differential impacts on complementary feeding practices but not on child growth results of a cluster randomized program evaluation in bangladesh |
| topic | stunting evaluation malnutrition child feeding children feeding child undernutrition experimental design |
| url | https://hdl.handle.net/10568/146492 |
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