Greater improvements in child growth and diet quality after a holistic community development intervention than after nutrition training alone LC Miller, N Joshi, M Lohani, BL Rogers, S Mahato, Su Neupane, Sh Neupane, S Ghosh, P Webb Photo Credit Goes Here
or more simply: Kids & families do better in communities which participate in comprehensive development activities
BACKGROUND Nutrition-sensitive agricultural interventions vary in their impact on child growth and diet J Nutrition (2007) 137: 2311 BMJ (2012) 344: d8222 Paediatr Perinat Epidem (2012) 26: 205 Household-level nutrition training programs also have variable success in improving these outcomes J Int Dev 19: 627 652 (2007) Food Nutr Bull 28:375-383 (2007) What happens if these interventions are combined?
Intervention: Heifer Nepal Intensive community & social capital development aimed at reducing poverty Livestock and values-based training in women s self-help groups
Project 2C Project 2B Project 2 Detour Project 1B Project 1
Project 2C Project 2B Project 2 Detour PROJECT 1B PROJECT 1
The intervention works household income and wealth 200000 HH INCOME 2 WEALTH SCORE NPR 150000 100000 50000 SES units 1.8 1.6 0 1.4
The intervention works child minimal dietary diversity and ASF consumption FOLD INCREASE related to duration of exposure to intervention 4 3 2 1 3.92 MDD p=.007 2.59 ASF p=.09 0 Food Policy 61 (2016) 185 197
The intervention works decrease in undernutrition 60 % of children 50 40 30 20 STUNTING UNDERWEIGHT 10 WASTING 0 J Devel Effectiveness, 2017, 9:101 Baseline 48 months all p<.0001
More questions. Can child growth be further improved? Can diet quality be further enhanced? How important is the community development component of Heifer s work to child and HH outcomes?
Project 2C Project 2B PROJECT 2 Detour Project 1B Project 1
Nutrition training Developed after completion of first project Reinforced in women s self-help groups by trained facilitators opractical demonstrations odidactic training
Methods Reviewed roster of communities in Banke district which had requested inputs from Heifer Nepal Communities (974 HHs) matched for specific characteristics were invited to participate Randomized 3 clusters
FULL HEIFER PROGRAM PARTIAL GROUP CONTROL GROUP Social Capital Development 1 year duration Nutrition Training Livestock Training Nutrition Training Livestock Training
Methods 5 HH surveys over ~33 months (independent research organization) HH INDICATORS Land Animals Wealth Income Food Security CHILD INDICATORS Anthropometry Health Diet quality (ASF, DDS) School attendance WOMEN S INDICATORS Empowerment Knowledge-Attitudes- Practices (child health, nutrition)
HHs included only if >75% participation in training Methods 5 HH surveys over ~33 months (independent research organization) HH INDICATORS Land Animals Wealth Income Food Security CHILD INDICATORS Anthropometry Health Diet quality (ASF, DDS) School attendance WOMEN S INDICATORS Empowerment Knowledge-Attitudes- Practices (child health, nutrition)
HH members 5725 5620 5789 Results: Participants 6238 6221 974 HHs ~6000 HH members Round 1 Round 2 Round 3 Round 4 Round 5 Children 1725 1744 1823 2042 2020 Round 1 Round 2 Round 3 Round 4 Round 5
Results: Community clusters Wealth score Income Income per HH member equivalent at baseline Soap use HH ASF consumption HH diet diversity (adults)
HH INDICATORS D baseline to 33 months 1.25 0.75 p<.0001 Control Full Heifer Partial 0.25-0.25 p<.001 p<.0001 p<.0001-0.75 WEALTH SOAP USES HH DDS FOOD SECURITY
HH INDICATORS D baseline to 33 months 1.25 0.75 p<.0001 Control Full Heifer Partial 0.25 Heifer group significantly more food insecure at baseline -0.25 p<.001 p<.0001 p<.0001-0.75 WEALTH SOAP USES HH DDS FOOD SECURITY
Soap use 6 * * # of soap uses reported 5 4 3 2 1 0 * * Control Full Heifer Partial Round 1 Round 2 Round 3 Round 4 Round 5 *p<.001
Child anthropometry at baseline: differed between groups Z scores 0-0.5-1 -1.5 HAZ WAZ WHZ HCZ MUACZ * * * * Control Full Heifer Partial -2-2.5
CHILD GROWTH INDICATORS D baseline to 33 months 1 0.75 p<.0001 p<.0001 Control Full Heifer Partial 0.5 p<.0001 0.25 p=.009 p=.006 0 HAZ WAZ WHZ HCZ MUACZ
Child diet at baseline Dietary diversity and ASF consumption equivalent
CHILD DIET QUALITY D baseline to 33 months 1.5 p<.0001 Control Full Heifer Partial 1 0.5 0 # FOOD GROUPS ASF CONSUMPTION
Mixed effects model adjusted for child and HH factors Age Gender Baseline anthropometry Caste Animal ownership Wealth Land ownership Women s education Women s empowerment Fixed effects: Group assignment Random effects: clustering at HH level
Mixed effects model Being in the intervention group predicted better growth outcomes WAZ HAZ WHZ
Being in the intervention group predicted greater improvement in child diet quality Diet diversity ASF consumption Mixed effects model
Being in the intervention group predicted greater improvement in child health Diarrhea Respiratory illness Fever (Composite score)
Strengths Longitudinal, prospective study with retention rate >96% Data collected by consistent independent research team Weaknesses Possible exposure to other programs in the area Somedifferences in communities at baseline Did not conduct separate validation of nutrition training
Summary Better outcomes were seen in families which received the full package of Heifer intervention, at both the child and HH level Child: More improvement in Growth (HAZ, WAZ, WHZ) Diet quality (ASF, DDS) Health (# of illness episodes) HH: Greater increases in Wealth Soap uses Diet diversity Food security
Conclusion Intensive, holistic interventions may be more effective in creating measureable and sustainable improvements in important child and HH outcomes.although these are more costly and more difficult to implement
Project 2 Detour Project 1B Project 1
Heifer Nepal Acknowledgements Heifer International Valley Research Group Nutrition Innovation Lab Participating families Photo Credit Goes Here
U.S. GOVERNMENT PARTNERS
धन यव द