Integrated Use of Social and Behaviour Change Interventions Improved Complementary Feeding Practices and Reduced Stunting in Amhara Region
- 1. Integrated Use of Social and Behaviour Change Interventions Improved Complementary Feeding Practices and Reduced Stunting in Amhara Region Authors: Sunny S Kim,1 Phuong Hong Nguyen,1 Yisehac Yohannes,1 Yewelsew Abebe,2 Manisha Tharaney,3 Elizabeth Drummond,4 Edward A Frongillo,5 Marie T Ruel,1 and Purnima Menon6 Affiliation: 1Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC; 2Alive & Thrive, FHI 360, Addis Ababa, Ethiopia; 3Alive & Thrive, FHI 360, Washington, DC; 4Save the Children USA, Washington, DC; 5Arnold School of Public Health, University of South Carolina, Columbia, SC; and 6Poverty, Health, and Nutrition Division, International Food Policy Research Institute, New Delhi, India Presenting Author: Yewelsew Abebe,Alive & Thrive, FHI 360, Addis Ababa | December 12, 2019
- 2. Alive & Thrive Presentation Outline Program background – Objectives and overview of interventions Study methods – Evaluation design – Sample size, data collection methods and data analyses Results – Sample characteristics – Infant and young child feeding (IYCF) practices and child growth Lessons learned & Program Implication
- 3. Alive & Thrive Project Background The Project used Social and Behavior Change (SBC) approach to promote appropriate infant and young child feeding ( IYCF) in two phases Phase One: In four regions 1 2 3 4 Phase Two: One region The SBC framework with four components
- 4. Alive & Thrive Objectives 1. Sustain high rates of exclusive breastfeeding (EBF) among children 0-5.9 months at over 70 percent in A&T program areas. 2. Increase the proportion of children 6-23.9 months who receive a diverse diet (consume at least 4 food groups) by 10 percentage points. 3. Increase the proportion of children 6-23.9 months who receive complementary food at least the minimum number of times per day by 10 pp.
- 5. Alive & Thrive Overview of Project Interventions 1. Timed and age-appropriate messaging (TAAM) about IYCF – Delivered by health extension workers (HEW) during home visits and health post visits – Delivered by women’s development army team leaders (WDATL) at home visits 2. Nutrition messaging and activities promoted by agricultural workers – Delivered by agricultural extension workers/development agents (AEW/DA) during any contact with 1000-day households – Promotion of “baby’s chicken” – Promotion of “baby’s vegetable garden” 3. Community mobilization activities – Monthly food demonstrations – Enhanced community conversations – Priests’ sermons about child feeding 4. Mass media campaign – “Sebat Mela” radio drama program
- 6. Alive & Thrive Study Location • 3 zones of Amhara region (Awi, N. Gondor, W. Gojjam), 20 non- PSNP woredas Impact Evaluation Design • Cluster-randomized program evaluation with repeated cross-sectional surveys • Random assignment of 20 woredas, to 10 A&T- intensive (A&T-I) and A&T non-intensive (A&T-NI) woredas 20 woredas in 3 zones 10 woredas A&T-I intervention areas TAAM + AEW messages+ Commo + mass media 10 woredas A&T-NI comparison areas Standard services + mass media Randomization Baseline survey: HH, HEW, WDATL, community (March-April 2015) Endline survey: HH, HEW, WDATL, AEW, community (March-April 2017) Rapid implementation study in 3 A&T-I Woredas (May 2016) Study Design
- 7. Alive & Thrive Results Impact on IYCF and Child Growth
- 8. Alive & Thrive Objective of maintaining high rates of EBF was achieved 75.7 86.3 50 60 70 80 90 100 2015 A&T-I 2017 A&T-I % EBF (<6m)
- 9. Alive & Thrive Minimum dietary diversity (MDD) and minimum acceptable diet (MAD) increased, with significant differential impact 5.2 24.9 4.9 18 2015 2017 MDD (6-23 months) A&T-I A&T-NI Percentofchildren6-23months DID: 6.6 pp+ 4.1 18.2 3 11.5 2015 2017 % MAD (6-23 months) A&T-I A&T-NI DID: 5.5 pp+ +p<0.1, *p<0.05, **p<0.01
- 10. Alive & Thrive +p<0.1, *p<0.05, **p<0.01, ***p<0.001 Adjusted for clustering effect at woreda level Significant Improvement In Consumption of Vitamin A rich Fruits & Vegetables as well as Eggs 0 20 40 60 80 100 Grains, roots and tubers Legumes and nuts Dairy Flesh foods Eggs VitA-rich fruits and vegetables Other fruits and vegetables % 2015 A&T-I 2015 A&T-NI 2017 A&T-I 2017 A&T-NI
- 11. Alive & Thrive Stunting among children 6-23months reduced significantly particularly among older children (18-23m) 36.3 22.8 35.4 27.6 0 10 20 30 40 50 2015 2017 % Stunting (6-23m) A&T-I A&T-NI DID: -5.6* - DHS showed a decline in stunting from 52 to 46 percent among children <5 years in Amhara, 2011-2016
- 12. Alive & Thrive Saturation Effect: Intensity of activities matter to adopt a behavior 13 Percenteggconsumption Number of A&T activities 9% 16% 23% 23% 34% 50% 0% 10% 20% 30% 40% 50% 60% 0 1 2 3 4 5+
- 13. Alive & Thrive Lessons Learned & Program Implication 1. Changing child feeding behaviors remains difficult , but this study results showed that improving MDD and MAD is possible through behavior change interventions even within a short 2-year period. 2. Intensity of exposure to interventions and appropriate messages are key. 3. Efforts to stunting reduction demands accelerated, high coverage and quality of services with adequate follow up! Program Implication This evidence and tools will have significant contribution for the national flagship program of stunting reduction if scaled up through system strengthening.
- 14. Alive & Thrive Acknowledgements • Health staff, HEWs, WDATLs, AEW/DAs • Respondent mothers and their communities • Funding was provided by Bill & Melinda Gates Foundation and CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
- 15. STAY CONNECTED WITH ALIVE & THRIVE @aliveandthrive www.facebook.com/fhi360.aliveandthrive www.lessguess.wordpress.com www.youtube.com/aliveandthrive www.aliveandthrive.org Thank you
Editor's Notes
- #4: Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behaviour change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM)
- #14: This example is from our sentinel surveillance data in Ethiopia, where one of the key messages was to feed children 6-23 months an egg. This message was delivered through multiple activities: health extension workers, volunteers, religious leaders, during community meetings, media, food demonstrations. The numbers across the bottom represent the number of these A&T activities to which a mother was exposed. As you can see, multiple contact points matter. Of women who were only exposed to 1 of these activities, 16% fed a child an egg. Compare that to the women were exposed to 5 or more different activities, half of which fed an egg to their child. Intensity matters.
- #17: Add image to fill the space above the turquoise box.