Given the high prevalence of child undernutrition in Bangladesh, multi-sectoral approaches involving livelihood promotion have potential to mitigate the burden of undernutrition. This study examined the impact of an economic development (ED) program providing poultry assets, gardening skills and saving training added to the Positive Deviant (PD)/Hearth program (PDH/ED), compared to PD/Hearth only (PDH). A total of 1029 children who attended PD/Hearth sessions in September-November 2018 at 6-13 months of age were enrolled in the cohort study in July-August 2019. The cohort, comprised of 532 children in the PDH/ED group and 593 children in the PDH group, was reassessed in November 2020. The program impact on child nutrition, food security, crop production, dietary quality and household income was estimated using a difference-in-differences approach accounting for the sociodemographic differences between PDH/ED and PDH groups. Compared to the PDH group, the PDH/ED group showed increases in child dietary diversity score (DDS) (+0.32), child minimum dietary diversity (13.7 percentage points [pp]), and maternal DDS (+0.28) (all p < 0.05). From 2019 to 2020, the PDH/ED households improved food security by 12.6 pp and diversified crop production (bananas (9.7 pp), papaya (11.1 pp), carrots (3.8 pp) and lemons (5.9 pp)), and increased the proportion of annual income ≥60,000 Taka by 12.4 pp and last month income ≥5000 Taka by 7.8 pp, compared to PDH group (all p < 0.05).However, there was no impact on child nutritional status, morbidity, livestock ownership and total annual/last income. Incorporating an ED program into nutrition programming could benefit food security and dietary diversity in rural Bangladesh.

Objectives Child undernutrition remains high in Bangladesh. Multi-sectoral approaches involving livelihood programs are needed to address the burden of undernutrition. This study examined the impact of an economic development (ED) program receiving poultry assets with/without gardening training added to the Positive Deviant (PD)/Hearth program in rural Bangladesh, compared to the PD/Hearth only (PDH), on child nutrition and health. Methods A total of 1,125 children aged 6–13 months with weight-for-age (WAZ) z-score&lt;−1.0 who attended PD/Hearth sessions in September – November 2018 were enrolled in a cohort group in July – August 2019 for the program evaluation. Out of them, 532 were from ED households (PDH/ED). The cohort group was re-assessed in November 2020. A year of program impact between 2019 and 2020 on food security, dietary quality, and health behaviors, accounting for the socio-economic differences between two groups, was estimated using a difference-in-differences approach. Results The prevalence of underweight in the PDH and PDH/ED group decreased to 18.6% and 24.7% (p = 0.02) in 2019, but increased to 47.7% vs. 56.2% (p = 0.003) in 2020 without significant difference in program impact by adding the ED. Compared to the PDH group, the PDH/ED group increased a child dietary diversity score by 0.32 score and minimum dietary diversity (defined as four out of seven food groups) by 13.7 percentage points (pp), and a maternal dietary score by 0.28 score. The PDH/ED increased the proportion of food secured households by 12.6 pp, diversified crop production for banana (9.7 pp), papaya (11.7 pp), carrot (3.8 pp), and lemon (5.9 pp) (all p &lt; 0.05), compared to the PD group. The proportion of households having income ≥ 84,000 Taka during the last year increased by 12.4 pp among PDH/ED group, compared to the PDH group (p = 0.003). There was no significant impact on child morbidity, maternal hand-washing practices. Conclusions Adding an ED program to the PD/Hearth program improved food security and dietary diversity among children and mothers in rural Bangladesh. Funding Sources World Vision Bangladesh.