Assessing the impact on child nutrition of Ethiopia’s Community-based Nutrition (CBN) Program
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Transcript of Assessing the impact on child nutrition of Ethiopia’s Community-based Nutrition (CBN) Program
Assessing the impact of Ethiopia’s Community-based Nutrition programme on child nutrition
Conducted by: Tulane University
Department of Global Community Health and Behavioural SciencesSchool of Public Health and Tropical Medicine
Community-based Nutrition (CBN)
Conducted by Volunteer Community Health Workers (VCHWs), supported by Health Extension Workers (HEWs)• Growth monitoring and promotion (GMP)• Monthly community conversations• Home follow up visits for growth faltering, sick
children• Health post referral for sick and/or malnourished
children• Community engagement via informal contact
CBN: expansion and scale-up
• Covered rural woredas in four agrarian regions: Amhara, Oromia, SNNPR and Tigray
• Launched in tranches, by groups of woredas• Present in 228 woredas by 2012, implemented
in four tranches
CBN Routine Data
TR 2 Baseline TR 3 Baseline Midline
.
CBN evaluation
Objectives• Assess plausible attribution
of changes in anthropometry to CBN activities
• Assess trends in knowledge and practice of good nutrition behaviours
• Describe programme implementation using process indicators
Methods• Four sample surveys conducted
following tranches 2 and 3• Covered ~60 clusters (census
enumeration areas)• Resampled households within
clusters at baseline and midline• Establishment of ‘control’
groups was not possible• Internal comparison possible
due to varying degrees of implementation
CBN evaluation: anthropometric changes
2008 2009 2010 2011 20120%
10%
20%
30%
40%
50%
60%
Change in stunting and severe stunting prevalence between baseline and midline (solid line), compared to expected stunting trend based upon DHS
historical data (dashed line, beginning at baseline estimate from evalua-tion survey), in TRANCHE 2
Stunting Preva-lence
Expected Stunting Trend
Severe Stunting Prevalence
Expected Severe Stunting Trend
DHS 2011 Stunting Prevalence
CBN evaluation: contact with HEWs and VCHWs
CBN evaluation: change in IYCF indicators
CBN evaluation: conclusions
• Potential for impact on both important process indicators and anthropometric outcomes
• Intensity of community contact likely very important for association of programme with outcomes
• Participation of 30% suggested need for focus on increasing as programme expanded
Future direction
• What is the impact of change from community level activity (VCHWs) to facility (health post) delivery (HEWs)?
• Coverage has increased dramatically, but how can the quality of interventions be ensured? Especially the ‘promotion’ component?
Reference: White, J., Mason, J. Assessing the impact on child nutrition of the Ethiopia Community-based Nutrition Program. Report to UNICEF of an evaluation study. Tulane University School of Public Health and Tropical Medicine, New Orleans. September, 2012.