Achieving behaviour change at scale: Alive &amp; Thrive's infant and young child feeding programme in Bangladesh

The burden of undernutrition in South Asia is greater than anywhere else. Policies and programmatic efforts increasingly address health and non-health determinants of undernutrition. In Nepal, one large-scale integrated nutrition program, Suaahara, aimed to reduce undernutrition among women and children in the 1,000-day period, while simultaneously addressing inequities. In this study, we use household-level process evaluation data (N = 480) to assess levels of exposure to program inputs and levels of knowledge and practices related to health, nutrition, and water, sanitation, and hygiene (WASH). We also assess Suaahara's effect on the differences between disadvantaged (DAG) and non-disadvantaged households in exposure, knowledge, and practice indicators. All regression models were adjusted for potential confounders at the child-, maternal-, and household levels, as well as clustering. We found a higher prevalence of almost all exposure and knowledge indicators and some practice indicators in Suaahara areas versus comparison areas. A higher proportion of DAG households in Suaahara areas reported exposure, were knowledgeable, and practiced optimal behaviors related to nearly all maternal and child health, nutrition, and WASH indicators than DAG households in non-Suaahara areas and sometimes even than non-DAG households in Suaahara areas. Moreover, differences in some of these indicators between DAG and non-DAG households were significantly smaller in Suaahara areas than in comparison areas. These results indicate that large-scale integrated interventions can influence nutrition-related knowledge and practices, while simultaneously reducing inequities.

Section: Discussionsupporting

confidence: 59%

supporting

confidence: 64%

Suaahara in Nepal: An at‐scale, multi‐sectoral nutrition program influences knowledge and practices while enhancing equity

Cunningham

Singh

Rana

et al. 2017

“…A recent network analysis of actors involved in supporting IYCF counselling (Puri et al, forthcoming) Learning and evaluation is highlighted as a significant contributor to scaling-up both in framework (Gillespie et al, 2015) and in successful examples of interventions operating at scale (Sanghvi et al, 2016).…”

Section: Governance (Source: Primary Review)mentioning

confidence: 99%

Scaling‐up interventions to improve infant and young child feeding in India: What will it take?

Avula¹,

Oddo

Kadiyala

et al. 2017

We assessed India's readiness to deliver infant and young child feeding (IYCF) interventions by examining elements related to policy, implementation, financing, and evidence. We based our analysis on review of (a) nutrition policy guidance and program platforms, (b) published literature on interventions to improve IYCF in India, and (c) IYCF program models implemented between 2007 and 2012. We find that Indian policies are well aligned with global technical guidance on counselling interventions. However, guidelines for complementary food supplements (CFS) need to be reexamined. Two national programs with the operational infrastructure to deliver IYCF interventions offer great potential for scale, but more operational guidance, capacity, and monitoring are needed to actively support delivery of IYCF counselling at scale by available frontline workers. Many IYCF implementation efforts to date have experimented with approaches to improve breastfeeding and initiation of complementary feeding but not with improving diet diversity or the quality of food supplements. Financing is currently inadequate to deliver CFS at scale, and governance issues affect the quality and reach of CFS. Available evidence from Indian studies supports the use of counselling strategies to improve breastfeeding practices and initiation of complementary feeding, but limited evidence exists on improving full spectrum of IYCF practices and the impact and operational aspects of CFS in India. We conclude that India is well positioned to support the full spectrum of IYCF using existing policies and delivery platforms, but capacity, financing, and evidence gaps on critical areas of programming can limit impact at scale.

“…Alive & Thrive (A&T) is a multiyear initiative aimed at reducing undernutrition and death caused by suboptimal IYCF practices. In Bangladesh, A&T used a combination of behaviour change communication strategies: interpersonal communication, mass media, and social mobilization to promote adequate IYCF practices and create an enabling environment for mothers and caregivers to adopt the recommended practices (Sanghvi et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…In February 2011, A&T also launched a national television and radio campaign. The TV campaign included six high‐quality spots with messages on breastfeeding (two spots) and complementary feeding issues (four spots) that were identified as gaps in current practices, based on formative research (Sanghvi et al, ; Sanghvi, Jimerson, Hajeebhoy, & Zewale, ). The description of the six spots are presented in Table .…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the uptake of a mass media intervention to improve child feeding in Bangladesh

Kim

Roopnaraine

Nguyen

et al. 2018

Mass media are increasingly used to deliver health messages to promote social and behaviour change, but there has been little evidence of mass media use for improving a set of child feeding practices, other than campaigns to promote breastfeeding. This study aimed to examine the factors influencing the uptake of infant and young child feeding messages promoted in TV spots that were launched and aired nationwide in Bangladesh. We conducted a mixed‐methods study, using household surveys (n = 2,000) and semistructured interviews (n = 251) with mothers of children 0–23.9 months and other household members. Factors associated with TV spot viewing and comprehension were analysed using multivariable logistic regression models, and interview transcripts were analysed by systematic coding and iterative summaries. Exposure ranged from 36% to 62% across 6 TV spots, with comprehension ranging from 33% to 96% among those who viewed the spots. Factors associated with comprehension of TV spot messages included younger maternal age and receipt of home visits by frontline health workers. Three direct narrative spots showed correct message recall and strong believability, identification, and feasibility of practicing the recommended behaviours. Two spots that used a metaphorical and indirect narrative style were not well understood by respondents. Understanding the differences in the uptake factors may help to explain variability of impacts and ways to improve the design and implementation of mass media strategies.