Impact - Nutrition in early childhood (UNICEF Goal Area 1.6)

Examples of the direct impact of social change and behaviour change strategies and action to improve nutrition in early childhood (part of UNICEF Goal Area 1).

For an outline of this overall process, including the selection criteria and links to the impact data for other UNICEF Goals please click on this link.

(NOTE - need to change that link so that it is space sensitive. Same with the The CI Summary links below)

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1. Cash-based interventions...

...had this direct impact:

"The odds of a child being wasted were significantly lower in the double cash (DC) arm after 6 mo (odds ratio [OR] = 0.52; 95% CI 0.29, 0.92; p = 0.02) compared to the control group (CG). Mean weight for height (WHZ) significantly improved in both the fresh food voucher (FFV) and DC arms at 6 mo (FFV: z-score = 0.16; 95% CI 0.05, 0.26; p = 0.004; DC: z-score = 0.11; 95% CI 0.00, 0.21; p = 0.05) compared to the CG. Significant differences on the primary outcome were seen only at 6 mo. All three intervention groups showed similar significantly lower odds of being stunted (height-for-age z-score [HAZ] < -2) at 6 mo (DC: OR = 0.39; 95% CI 0.24, 0.64; p < 0.001; FFV: OR = 0.41; 95% CI 0.25, 0.67; p < 0.001; SC: OR = 0.36; 95% CI 0.22, 0.59; p < 0.001) and at 1 y (DC: OR = 0.53; 95% CI 0.35, 0.82; p = 0.004; FFV: OR = 0.48; 95% CI 0.31, 0.73; p = 0.001; SC: OR = 0.54; 95% CI 0.36, 0.81; p = 0.003) compared to the CG. Significant improvements in height-for-age outcomes were also seen for severe stunting (HAZ < -3) and mean HAZ."

• Country: Pakistan
• Methodology: Randomized Control Trial; 2,496 very poor households with children 6-48 months .

Journal Source: PLoS Medicine; 2017 - Impact evaluation of different cash-based intervention modalities on child and maternal nutritional status in Sindh Province, Pakistan, at 6 mo and at 1 y: A cluster randomised controlled trial

The CI Summary:

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2. A preschool-based intervention aimed at improving knowledge, attitudes, and habits related to healthy diet and active lifestyle...

...had this direct impact:

"Children in the intervention group showed a 10.9% increase ... compared with 5.3% in controls ... Among parents, the equivalent statistics were 8.9% and 3.1% ... and among teachers, 9.4% and 2.5%, respectively."

• Country: Usaquén, Bogota, Colombia
• Methodology: Cluster randomized controlled trial; 1216 children, 928 parents, and 120 teachers

Journal Source: The American Journal of Medicine; 2013 - Targeting Preschool Children to Promote Cardiovascular Health: Cluster Randomized Trial

The CI Summary: Targeting Preschool Children to Promote Cardiovascular Health

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3. Community-based participatory nutrition education...

...had this direct impact:

"A positive impact on child dietary diversity was observed (B (SE) = 0.39 (0.15), p = 0.01; 95% CI 0.09–0.68)."

• Country: Malawi
• Methodology: Cluster-randomized-controlled trial; 1,791 households

Journal Source: PLOS ONE; 2017 - Nutrition education improves dietary diversity of children 6-23 months at community-level: Results from a cluster randomized controlled trial in Malawi

The CI Summary:

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4. Intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM)...

...had this direct impact:

Large differential improvements of 12-17% in intensive, compared with nonintensive areas for early initiation of and exclusive breastfeeding, timely introduction of foods, and consumption of iron-rich foods.

• Country: Bangladesh
• Methodology: Cluster-randomized design with repeated cross-sectional surveys; baseline (n = 2,188), endline (n = 2,001), and follow-up (n = 2,400)

Journal Source: The Journal of Nutrition; 2018 - Large-scale social and behavior change communication interventions have sustained impacts on infant and young child feeding knowledge and practices: results of a 2-year follow-up study in Bangladesh

The CI Summary: Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices

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5. Cash transfers and/or social and behavioral change communication (SBCC)...

...had this direct impact:

At 24 mo of age, children who received unconditional cash transfer (UCT) + liquid nutritional supplement (LNS) [rate ratio (RR): 0.85; 95% CI: 0.74, 0.97; P = 0.015) and UCT + LNS + social and behaviour change communication (SBCC) (RR: 0.86; 95% CI: 0.77, 0.96; P = 0.007) had a significantly lower risk of being stunted compared with the UCT alone arm.

• Country: Pakistan
• Methodology: 4-arm, community-based cluster randomized controlled trial; 1,729 children

Journal Source: American Journal of Clinical Nutrition; 2021 - Effectiveness of unconditional cash transfers combined with lipid-based nutrient supplement and/or behavior change communication to prevent stunting among children in Pakistan: a cluster randomized controlled trial

The CI Summary: Effectiveness of Unconditional Cash Transfers Combined with Lipid-based Nutrient Supplement and/or Behavior Change Communication to Prevent Stunting among Children in Pakistan

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6. Behaviour change, community mobilization, and mass media...

...had this direct impact:

Complementary Feeding (CF) improvements were significantly greater in the intensive than in the non-intensive group [difference-in-difference impact estimate: 16.3, 14.7, 22.0, and 24.6 percent 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.

• Country: Bangladesh
• Methodology: Cluster-randomized, nonblinded evaluation with cross-sectional surveys; 1,600 children

Journal Source: The Journal of Nutrition; 2016 - 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

The CI Summary: 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

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7. Behaviour change communication (BCC), cash transfers, and food rations...

...had this direct impact:

BCC improved infant and young child nutrition (IYCN) knowledge substantially in the 1st year of the intervention; participants correctly answer 3.0-3.2 more questions (36% more) compared to the non-BCC groups. Knowledge persists; there were no significant decreases in IYCN knowledge 6-10 months after nutrition BCC activities ended.

• Country: Bangladesh
• Methodology: RCT with 2,341 participants

Journal Source: Maternal and Child Nutrition; 2017 - Nutrition behaviour change communication causes sustained effects on IYCN knowledge in two cluster-randomised trials in Bangladesh

The CI Summary: Nutrition Behaviour Change Communication Causes Sustained Effects on IYCN Knowledge in Two Cluster-Randomised Trials in Bangladesh

 

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8. Interpersonal counseling (IPC), community mobilisation, and mass media...

...had this direct impact:

Greater improvements in the intensive than in the nonintensive group were seen for minimum dietary diversity [DDE: 6.4 percentage points (pps); P< 0.05] and minimum acceptable diet (8.0 pps; P< 0.05).

• Country: Vietnam
• Methodology: Cluster-randomised, nonblinded evaluation with cross-sectional surveys; 500 children aged 6-23.9 months and 1,000 children aged 24-59.9 months

Journal Source: Journal of Nutrition; 2017 - Social Franchising and a Nationwide Mass Media Campaign Increased the Prevalence of Adequate Complementary Feeding in Vietnam: A Cluster-Randomized Program Evaluation

The CI Summary: Social Franchising and a Nationwide Mass Media Campaign Increased the Prevalence of Adequate Complementary Feeding in Vietnam

 

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