Friday, February 15, 2008

Better outcome through targeted nutrition programs aimed at changing behavior

What happens when nutrition programs are just not aimed at filling hungry or malnourished stomach but are aimed at changing general nutrition behavior like feeding and hygiene practices? Well, obviously the outcome would be much more better and optimal than a simple feeding program. This is corroborated by this new research brief, based on an experimental nutrition program in Madagascar, from the WB research institute.

In a new research brief, Galasso and Umapathi describe a recent impact evaluation study of a community-based nutrition program in Madagascar which targeted the country’s most malnourished and vulnerable districts. The study highlights links between maternal education, knowledge, and community infrastructure that can help achieve improvements in child nutrition. Results show that malnutrition can be improved over the short- and long-term when mothers participate in community nutrition programs that promote behavioral change in nutrition, feeding, and hygiene practices. However, the gains from this program were higher for better-educated mothers and households in the relatively advantaged areas. While knowledge is a necessary condition for achieving progress, direct interventions on the nutrition front, bundled with complementary assistance in other sectors (health, infrastructure, and water and sanitation), is the best way to maximize effectiveness in the neediest areas, the authors say.


The figure to the right shows that communities participating in the program bridged the weight gap with respect to non-participating communities in terms of short-term nutritional outcomes (weight for age z-scores reduced by 0.15-0.22 standard deviations and the incidence of underweight children reduced by 5.2-7.5 percentage points).

The overall share of observed improvements in nutrition nationwide (reduced malnutrition rates) between 1997/98 and 2004 attributable to the program (using the estimates above) ranges between ¼ and ⅓.


The figure to the left on height shows the protective effect of the program on longer-term nutritional outcomes (reversing the trend in stunting). This result is particularly important in light of the fact that program communities had a higher incidence of shocks and experienced higher food insecurity.

The observed program effects were obtained through significant improvements in feeding practices (exclusive breastfeeding, timing of weaning, and proactive and responsive feeding) and hygiene practices (appropriate disposal of garbage and toilet use, and improved methods of water purification).

Two expected, yet significant, results from the study:

  1. More educated mothers and households living in better-off areas gain more from the program
  2. Knowledge is a necessary but not sufficient condition for improving nutritional outcomes for households with limited access to complementary resources