Effectiveness of a Community-Based Intervention to Improve Nutrition in Young Children in Senegal : A Difference in Difference Analysis

There are few studies of community growth promotion as a means of addressing malnutrition that are based on longitudinal analysis of large-scale programmes with adequate controls to construct a counterfactual. The current study uses a difference in difference comparison of cohorts to assess the impact on the proportion of underweight children who lived in villages receiving services provided by the Senegal Nutrition Enhancement Project between 2004 and 2006. The project, designed to extend nutrition and growth promotion intervention into rural areas through non-governmental organisation service providers, significantly lowered the risk of a child having a weight more than 2 sd below international norms. The odds ratio of being underweight for children in programme villages after introduction of the intervention was 0.83 (95% CI 0.686, 1.000), after controlling for regional trends and village and household characteristics. Most measured aspects of health care and health seeking behaviour improved in the treatment relative to the control.

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The Potential for Integrating Community-Based Nutrition and Postpartum Family Planning : Review of Evidence and Experience in Low-Income Settings
(World Bank, Washington, DC, 2013-11) Alvesson, Helle M.; Mulder-Sibanda, Menno
The objective of this review was to study where community-based family planning and nutrition programs have been integrated, how this has been accomplished, and what the results have been. Although family planning is a nontraditional intervention in community-based nutrition programs, it can have profound effects on maternal and child health and nutrition. When family planning does not occur, short intervals between pregnancies deplete mothers' reserves of nutrients needed for pregnancy and later for breastfeeding. As a result, short birth intervals are associated with higher maternal and neonatal mortality and malnutrition rates of infants. Family planning, which promotes contraceptive use and the lactational amenorrhea method, can thus improve nutrition outcomes in both mothers and babies. The authors identified a few studies on integrated services in the published literature; thus the main part of the review is built on operational research studies and unpublished smaller scale intervention studies. However, the controlled studies that were identified indicate positive correlation between breastfeeding levels and increased contraception use. Additionally, although the design of the intervention studies did not make it possible to assess the degree to which integration had an impact, the studies did highlight factors that were key to a successful integration process. These are community engagement; multiple and frequent contact points between mothers, community volunteers, and health workers; involvement of husbands; moving implementation decisions closer to the users of the program; and assuring transparency, clarity, and simplicity in the transmission of development objectives to communities.
Investing in Young Children : An Early Childhood Development Guide for Policy Dialogue and Project Preparation
(World Bank, 2011) Naudeau, Sophie; Kataoka, Naoko; Valerio, Alexandria; Neuman, Michelle J.; Elder, Leslie Kennedy
Investing in young children is the responsible thing to do. All children deserve a chance to grow into healthy, educated, and competent people, no matter where and when they were born. While parents bear most of the responsibility for raising their children, especially in the early years of life, governments also have an important role during this critical time of human capital accumulation. For example, governments can ensure that all expectant mothers and young children have access to quality health services and nutrition. They can support parents and other caregivers in providing a positive and stimulating environment for children from birth on by promoting parenting information programs, investing in direct services such as home-based visits, funding daycare centers and preschools, or providing financial incentives to access good quality programs for infants and children. This Early Childhood Development (ECD) guide presents lessons and experiences that have been useful in informing the policy debate about ECD interventions and the design of such programs across the world. Whether the user of this guide is at the initial stage of deciding whether to expand an ECD portfolio or already in the program design stage, the content offers a range of evidence- based options to inform policy and investment choices.
Who Should Implement Nutrition Interventions? The Application of Institutional Economics to Nutrition and the Significance of Various Constraints to the Implementation of Nutrition Interventions
(World Bank, Washington, DC, 2000-12) Rokx, Claudia
Much has been learned about the significance of malnutrition for individuals and for society as a whole in the past two decades. An adequately nourished population has a better chance of reaching full intellectual capacity and economic productivity and enjoying an adequate quality of life. Experience shows that nutrition interventions significantly help to reduce malnutrition but that implementing them is difficult and influenced by multiple constraints. An overview of the literature of the past two decades on implementing nutrition activities and interventions provides insights into the many factors, both positive and negative, believed to affect this process. The purpose of this paper is to analyze each factor's relative importance in the implementation of nutrition interventions. The findings of this study strongly suggest that closer attention should be paid to the factors that are significant in predicting disbursement for nutrition in World Bank projects.
Almost Random : Evaluating a Large-scale Randomized Nutrition Program in the Presence of Crossover
(Washington, DC: World Bank, 2008-11) Linnemayr, Sebastian; Alderman, Harold
Large-scale randomized interventions have the potential to uncover the causal effect of programs applying to a large population, thereby improving on the insights gained from currently dominant smaller randomized studies. However, the external validity gained through larger interventions typically implies less supervision and often comes at the cost of some deviation from the randomization plan. This paper investigates the impact of the Nutrition Enhancement Program, which aims to improve child nutrition in Senegal based on a large-scale randomized community intervention. The analysis explicitly deals with deviation from the planned treatment and suggests approaches for combining ex-post adjustments such as propensity score matching with the randomized treatment plan. The authors do not detect a strong overall program impact on the outcome measure of weight-for-age based on planned treatment status, but do find an impact on the youngest children. Moreover, the project impact is clearer when the analysis considers treatment crossover using alternative estimators of two-stage least-squares and propensity score matching. The findings underscore the importance of addressing the shortcomings of large-scale randomization interventions in a systematic manner in order to understand the selection process that can guide further implementation of such projects, as well as to expose the true, causal effect of such programs.
Determinants of Malnutrition in Senegal : Individual, Household, Community Variables, and Their Interaction
(2008) Linnemayr, Sebastian; Alderman, Harold; Ka, Abdoulaye
The relationship between poverty and nutrition is a two-sided one: on the one hand, economic growth (which is generally associated with an eradication of poverty) leads to reduced malnutrition. On the other hand, nutrition is one of the key ingredients for human capital formation, which in turn represents one of the fundamental factors of growth. There are numerous studies that show the correlates of malnutrition using both household- and community-level variables. However, few of these studies allow for the potential endogeneity of community infrastructure or indicate their interplay with characteristics of the mother. The current study considers the socio-economic determinants of child malnutrition and investigates how programs compensate for the increased risks facing young mothers and their children or substitute for a low social status of the mother in the household. The empirical results show that children of mothers giving birth at a young age are disadvantaged in terms of their anthropometric status. Interaction effects of the presence of a non-governmental organization (NGO) or a health post in the village with characteristics of the mother stress the important role played by these institutions in helping disadvantaged mothers overcome their difficulties. These findings have implications for efficient program design and represent a further step towards gaining an improved understanding of the complex determinants of child (mal)nutrition.

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