Impact of Enhanced NutritionImpact of Enhanced Nutrition ...
Transcript of Impact of Enhanced NutritionImpact of Enhanced Nutrition ...
Impact of Enhanced NutritionImpact of Enhanced Nutrition Program on Child Growth and g
Diet in India
Rasmi Avula1,Edward A. Frongillo1, Mandana Arabi2 Rasmi Avula ,Edward A. Frongillo , Mandana ArabiSheel Sharma3, Werner Schultink2
October 9, 2009October 9, 2009
1University of South Carolina; 2UNICEF; 3Banasthali University
F d d b UNICEFFunded by: UNICEF
C nt t
Prevalence
Context
Prevalence 60 million children underweight46% stuntedInter-state variation
India’s Policy ResponseIntegrated Child Development Services (ICDS)
Anganwadi Centers
Gragnolati, M., Shekar, M., Gupta, M., Bredenkamp, C., & Lee, Y. (2005). India’s undernourished children: A call for reform and action. Health Nutrition & Population Discussion Paper.
S ppl t l N triti Pr rSupplemental Nutrition ProgramChildren receive food in ready-to-eat Children receive food in ready to eat form, hot-meal cooked at the AWC, or as a take-home rationFood centrally procured from public or private vendors at the national or state level
Pr blProblemsIrregularities in the food supplyIrregularities in the food supplyLeakage to non-targeted individualsLack of awareness among the mothers Lack of awareness among the mothers about the food or eligibility of their childrenFailure of the AWW to contact the mother when food is available
Obj tiObjectiveAssess the effect of an enhancedssess t e e ect o a e a cedsupplemental nutrition program on growthand dietary outcomes among 6-36 monthsy gchildren
P E h tProgram Enhancement
Usual Program GroupUsual Program GroupCentrally procured Baby Mix
E h d N i i Enhanced Nutrition Program Group
Locally prepared Baby Mix Locally prepared Baby Mix Anuka (Multiple Micronutrient Supplement)M it iMonitoring
Q antitative St d MethodsQuantitative Study Methods
Study Designy gQuasi-experimental pre-post test design
Sample30 villages (N = 1190)
15 villages from one block in the enhanced program 15 villages from another block in the usual program
MeasuresHeight and Weight (6-36 months children)24-hour Dietary Recall (6-18 months children)
An l
Multi-level Linear Regression
Analyses
Multi level Linear Regressionchange over time between the groupsaccounted for village-level variation
Growth OutcomesHAZ, WAZ, and WHZ HAZ, WAZ, and WHZ control variables - age, initial Z score
Di t O tDietary OutcomesEnergy, Protein, and Iron control variables - age, initial nutrient intake, and gbreastfeeding status
Qualitative Study MethodsQualitative Study Methods
Site VisitSite Visit
Interviews with key personnelInterviews with key personnelProject Officer at UNICEFChild Development Project Officer (ICDS)Child Development Project Officer (ICDS)Anganwadi WorkersMothers
R lt G th O tResults – Growth Outcome
Change in Height-Age-Z Score
0 8*p<0.05
0.6
0.7
0.8
ed-U
sual
**
0.3
0.4
0.5
ce: E
nhan
ce(S
D)
0
0.1
0.2
Diffe
renc
6-8 9-11 12-18 19-25 26-31 32-36
Age in Months
Results Growth OutcomeResults - Growth Outcome
Change in Weight-Age-Z Score
3*p<0.05
2
2.5
ced-
Usua
l
*
1
1.5
nce:
Enh
an(S
D)
**
0
0.5
6-8 9-11 12-18 19-25 26-31 32-36
Diffe
ren
6-8 9-11 12-18 19-25 26-31 32-36
Age in Months
R lt G th O tResults - Growth Outcome
Ch i W i ht H i ht Z SChange in Weight-Height-Z Score
3*p<0.05
*
2
2.5
ced-
Usua
l
0 5
1
1.5
ce: E
nhan
c(S
D)
*
-0 5
0
0.5
6-8 9-11 12-18 19-25 26-31 32-36Diffe
ren
0.5
Age in Months
R lt Di t O tResults - Dietary Outcome
Ch i E I t kChange in Energy Intake
160
al
* <0 05
100
120
140
nced
-Usu
ad)
* *p<0.05
40
60
80
ence
: Enh
a(k
cal/ d BOYS
GIRLS
0
20
40
6 8 9 11 12 18
Diff
ere
6-8 9-11 12-18Age in Months
Q lit ti St d R lt
Decentralization of Baby Mix
Qualitative Study Results
Decentralization of Baby MixCentral procurement vs. local preparationQuality of the productQ y pAcceptability
TrainingCounseling skillsDemonstration of administration of the supplement with the Baby Mix
Q lit ti St d R ltQualitative Study Results
Child Dev Project
Monitoring
Dept. DirectorChild Dev. Project Officers
Lady Supervisors Anganwadi Workers
MonitoringRecord MaintenanceIncreased visitsIncreased visitsAdequate Staff
C l iConclusionsProgram enhancement benefited children
Plausibility of benefit is supported by y pp yqualitative study results
Observed outcomes can be attributed to: local preparation of Baby Mixtraining and monitoringuse of micronutrient supplement
AcknowledgementsAcknowledgements
Dr Laxmi Bhawani CDN Project Officer UNICEF JaipurDr. Laxmi Bhawani - CDN Project Officer, UNICEF, Jaipur.UNICEF Staff, JaipurTonk and Malpura Block ICDS Personnel Banasthali University Technical Team Members, RajasthanMothers in Tonk and Malpura Block villages Ashok Patni – Data entry assistantyPink City - NGO, JaipurSanskriti – NGO, Jaipur