Transcript EPRG-7-NDP-outputs-09

Impact of Deworming and Micronutrient
Supplementation on Maternal and Child
Nutritional status
End-line Preliminary Findings
from a
Randomised Control Trial in North-West Bangladesh with NDP
1
Project activities
Economic Empowerment/ Livelihood component:
1. Creating access to land
•Land leasing
•Promotion of share-cropping
2. Vegetables production and consumption
3. Cash support
2
Nutrition Component:
1. Behaviour Change Communication
•Cooking demonstration
•IYCF messages – Group meeting
•Hygiene and Sanitation
2. Micronutrient supplements (MNS)
3. Regular deworming
3
Total BHHs
Excluded
(n = 15)
1043 BHHs
Intervention
Group
Control
Group
Baseline nutrition survey
Provision of supplements
After 6 months
of
supplementation
After 12 months
Control group
will receive 3
months of
supplementation
Intervention
Group
October 2010
December 2010
Control
Group
Midline nutrition survey
May-June 2011
End-line survey
December 2011
Figure : Trial profile
4
Methodology:
1. Longitudinal Panel study
2. Cluster Randomised Trial
3. Mixed Method (Qualitative & Quantitative)
4. Sample size (Quantitative):
1043 BHHs
537 Intervention
503 Control
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OBJECTIVES
Quantitative Surveys:
Through the bi-annual surveys (midline and end-line surveys)
the project aims to determine:•intra-individual biannual change in nutritional status
•Change in household food intake and food security status.
•and, as such, the outcomes of the nutrition intervention
package.
Qualitative Investigation:
Capture the lessons learned
Beneficiary perspectives
Management issues
Guidance for scaling up and future project planning
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Data collected on: (Quantitative)
1. Socio-demography
2. Anthropometry
3. Blood Haemoglobin
4. Morbidity
5. Household Food Intake
6. Food Coping Mechanism (Food
Security)
7
Preliminary
Findings from the
End-line Survey
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Compliance:
•Sprinkles were taken and liked by everyone
•It was seen as an ‘asset’, “the rich have meat and fish, and we
have pushti’.
•The control group wanted it.
• Sharing pushti with other members of the family - The
mothers admitted that about once a week they do this don’t
share with husbands or much older kids – it’s seen as a
women and kids item.
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Household Food Intake
1. Mean no of food items consumed
2. Another way of measuring food diversity
based on 7 food groups as defined by
WHO/UNICEF
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Households asked whether eaten 13 food items in
the previous 7 days – provides a measure of food
diversity
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Improvement from survey 1 (6.42 foods) to 8.77 foods
in survey 2 continued to 9.5 in survey 3
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Measuring food diversity based on 7 food groups as defined by
WHO/UNICEF
5.9799
Mean Food Diversity (7 food
Groups)
6.0000
5.0000
5.4337
4.5643
5.9737
5.9667
5.3604
5.2794
4.5211
4.5437
4.0000
3.0000
2.0000
1.0000
.0000
Intervention
Baseline
Control
Midline
Total
Endline
Grains, roots and tubers, legumes and nuts, dairy products, flesh foods, eggs, vitamin A rich fruits and
vegetables
HOUSEHOLD FOOD SECURITY
Households asked about 10 food coping strategies
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Mean Food Coping Strategy fell from 4.56 to 2.2
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Maternal Nutritional Status
1. Anthropometry
1. Change in body weight
2. Change in Body Mass Index (BMI)
3. Chronic energy deficiency (CED)
Measured by BMI
2. Haemoglobin (Anaemia)
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Mother’s Mean Haemoglobin concentration by HH head
17
Upward trend in blood heamoglobin
concentration was found in both male and female
headed households
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Mean Haemoglobin Concentration
(g/l)
Intervention
128.00
Control
Total
127.38
126.08
125.29
126.00
124.00
124.26
122.65
122.00
120.16
120.00
118.00
116.00
Male Headed
Household
Female Headed
Household
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Mother’s Mean Haemoglobin concentration in control and Intervvention group, after
removing the effect of mother’s age and sex of the HH head
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Change in Child (U-5)
Nutritional Status
1. Anthropometry
1. Weight for Height (wasting)
2. Weight for Age (underweight)
3. Height for Age (stunting)
2. Haemoglobin (Anaemia)
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Change in mean weight and height
22
Weight for Height Z-Scores (WHZ)
23
24
Height for Age Z-Scores (HAZ)
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Baseline
52
Midline
50.9
Prevalence of Stunting
50
49.8
49.4
50
48
46.5
45.4
46
44
44
Endline
43.8
42.9
42
40
38
Intervention
Control
Total
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Weight for Age Z-Scores (WAZ)
27
Baseline
Prevalence of Underweight
60
54.6 55.7
49.4
Midline
53.5
49.5 50
Endline
51.4 52.1
50
45.2
40
30
20
10
0
Intervention
Control
Total
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Haemoglobin Concentration (Children-U5)
29
Baseline
Change in Prevalence of anaemia
among U-5 Children
60
53.5
Midline
Endline
53
52.7
50
43.9
40
31.3
27.3
30
21.1
17.2
20
10
7.9
0
Intervention
Control
Total
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Before the intervention
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After the intervention
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Limitation of the study
1. No socio-economic information
2. Lack of detailed dietary data
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THANKS
34
Baseline
Midline
Endline
2.00
1.80
1.80
1.60
1.40
1.25
1.13
1.20
1.00
.78
.80
.66
.59
.60
.45
.36 .33
.40
.20
.63
.57
.10
.05 .06
.33
.07 .04 .05
.00
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Intervention
Control
Total
Prevalence of Anemia among U-5
Children
60
50
40
30
20
10
0
Baseline
Midline
Endline
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Micronutrient
Vitamin A
Vitamin C
Vitamin D
Vitamin E
Vitamin B1
Riboflavin
Niacin
Pyridoxine
Vitamin B12
Folic acid
Iron
Zinc
Copper
Selenium
Iodine
Contents of each 1 gm sachet
0.4mg
30mg
0.005mg
5mg
0.5mg
0.5mg
6mg
0.5mg
0.0009 mg
0.15mg
10mg
4.10mg
0.56mg
0.017mg
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0.09mg
Methodology: (Mixed)
1. Quantitative (Longitudinal trial)
Structured Questionnaire
Anthropometric and Hb Measurement
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2. Qualitative Investigation
Focus Group Discussions (BHHs)
In-depth Interviews
Interviews of project staff
And.....
3. NDP’s
Monitoring
Data
39
ATTRITION
Reasons for
attrition
Migration
Not participating
in programme
activities
Morbidity and
Mortality
Others
Attrition
(number)
Intervention
Control
group
group
19
32
Attrition
(%)
Interventio Control
n group
group
3.54
6.36
11
6
2.05
1.19
1
15
0.19
2.98
19
15
3.54
2.98
Total attrition rate 11.31% - Information was collected on
927 mothers and 298 under 5 years old children.
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COMPLIANCE
mothers
children
U5
% of targeted beneficiaries
receiving antehelmintics
94.1
98.1
% of targeted beneficiaries
receiving MNP sprinkles
94.1
98.0
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Household Food Intake
MFC- increased from 6.41 to 8.77
MFD- increased from 4.44 to 5.01
Figure 2: Mean number of food types consumed Figure 3: Mean food diversity by control and
by control and intervention group
intervention group
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animal protein consumption has improved significantly
•meat and poultry consumption have increased
from 3.3% and 6.6% to 13.5% and 23.7%
respectively,
•eggs (14.1% to 45.4%)
•milk (21.7% to 58.3%)
•dried fish (32.6% to 67.2%)
•fresh fish (66.2% to 80.1%)
•Green veg. 96.6% to 96.1%
•Other veg. 82.0% to 98.8%
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Household Food Security
with a
fall in
mean
number
of coping
strategies
used from
4.56 to
3.77
Figure 4: Mean food coping strategy by control and intervention
groups
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Most beneficiaries consumed fish and egg
maybe twice a month
 That fish and egg was divided 3 or 4 ways
among family members.
Consuming more vegetables and slightly more
rice than before, as they could sell the
vegetables and purchase rice and also had 40
taka wage supplementation
when they
worked on their fields
45
Most families could afford about 50grams of cooking oil per week (i.e. very
little). Only one even mentioned eating 100 gm of dal in a week.
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Morbidity
Condition
Day of survey
Previous 7 days
Previous 30 days
Baselin
e
Midline
p
Baseline
Midline
p
Baseline
Midline
P
10.5
6.0
0.023
29.2
24.1
ns
42.6
38.1
ns
8.5
3.6
0.002
34.7
20.5
<0.001
44.6
31.9
<0.001
9.4
4.8
<0.001
32.2
22.2
<0.001
43.7
34.9
<0.001
20.6
14.6
0.022
48.8
25.2
<0.001
65.0
33.6
<0.001
21.4
10.6
<0.001
49.9
19.9
<0.001
69.9
25.4
<0.001
21.0
12.5
<0.001
49.0
22.5
<0.001
62.8
29.4
<0.001
Diarrhoea
Control
Intervention
Total
Passed worms
Control
Intervention
Total
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Intervention
gp
After veg
After sprinkles








Reduced illness
Cold-Fever
headaches
weakness/dizziness
diarrhoea/worms
cold sores/lesions on lips





More of the previous +
Greater increase in
appetite
More energetic,
normal health
Kids with sprinkles no
illness compared to her
older brother
Older women said she’s
not dizzy and tired and
working more
‘after taking sprinkles,
sickness reduced so
appetite increased’
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After veg
After sprinkles
Control
Less dizzy and weak, less
fainting,
Intervention group
look livelier and
more energetic
Control
No fever
No jaundice
Not loose motion
Better eyesight
Walking stick gone!
Some of us have
higher haemoglobin!
49
Greater appetite was reported by all 6 groups.
Their appetite increased after starting consuming
vegetables and practicing hygiene, and rose further
with taking the sprinkles.
It was chiefly seen as a primarily function of reduced
chronic ill-health
Before the intervention they claimed that when
working sometimes they felt they had to stop because
of weakness, tingling, dizziness and fainting.
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Nutritional Status of Mothers
Variables
Control Group
Intervention group
CMS3 March 2011
Change
Change
Survey
Survey
Survey
P
Baselin Midline
Baselin Midline
Mar 10 Mar 11
e
e
No changes are significant
Mean values
Weight
39.57
BMI
18.11
Haemoglobin
117.78
Categories
BMI <18.5
63.4
Anaemic
51.7
40.16
40.10
41.29
18.19
18.73
118.76
122.59
58.0
51.6
53.3
33.6
0.59
18.37
0.26
118.80
1.02
56.3
+7.1
51.7
0
1.19
0.54
3.83
+6.4
+19.7
41.8
42.2
18.9
19.0
116.0
115.7
53.1
51.5
58.5
56.2
0.4
0.1
-0.3
+1.6
+2.3
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Child Nutritional Status
Groups
Control
Intervention
Nutritional
status
Mean
Survey
Baseline
Midline
Height-for-age
-1.83
-1.73
ns
Stunting
Weight-for-age
-2.13
-2.05
Weight-forheight
Haemoglobin
-1.57
-1.57
107.43
p
Survey
Prevalence
(%)
Baseline
Midline
50.5
46.2
ns
ns
Underweight 51.6
51.6
ns
ns
Wasted
34.1
29.7
ns
50.5
42.4
ns
41.6
53.1
ns
ns
33.6
25.7
0.049
53.2
20.2
<0.001
112.21 0.004 Anaemic
Height-for-age
Weight-for-age
-1.53
-1.98
-1.51
-1.88
ns
ns
Stunting
38.9
Underweight 50.4
Weight-forheight
Haemoglobin
-1.6
-1.5
ns
Wasted
107.06
P
118.14 <0.00 Anaemic
1
52
Indicators
(Change between baseline and
midline)
Height-for-age
Weight-for-age
Weight-for-height
Haemoglobin (g/l)
Indicators
Height-for-age
Weight-for-age
Weight-for-height
Haemoglobin (g/l)
Intervention
(Midline –
Baseline)
Control
(Midline –
Baseline)
(Intervention –
Control)
CMS3 March
2011
+0.02
+0.099
+0.11
+0.086
-0.088
+0.013
+0.085
-0.15
+0.24
-0.16
-0.14
-0.07
+11.35
+5.14
+6.39
NDP Midline
+4.0g/L
CMS3 March 2011
0.5 % less stunting
2% more stunting
1 % more underweight
1.0% more underweight
6.4 % less wasting
1.0% less wasting
22 % less anaemia
11% less anaemia
Intervention- 30% less anaemia
Control- 8.1% less anaemia
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Challenges faced and Lessons learned:
Integrating Nutrition
Nutrient content
BCC components (Strengthen)
IYCF messages
Messages for PW and BF motheres
Strong Intervention Monitoring
Well desinged structure
Staff turnover
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Contents:
 Background and General Project Activities
Study Design
 Changes in Nutritional Status
 Qualitative findings
 Limitations
 Challenges Faced
 Learnings
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