Improving Nutritional Status Through Behavioral Change : Lessons From Madagascar

Abstract

This paper provides evidence of the effects of a largescale intervention that focuses on the quality of nutritional and child care inputs during the early stages of life. The empirical strategy uses a combination of double-difference and weighting estimators in a longitudinal survey to address the purposive placement of participating communities and estimate the effect of the availability of the program at the community level on nutritional outcomes. The authors find that the program helped 0-5 year old children in the participating communities to bridge the gap in weight for age z-scores and the incidence of underweight. The program also had significant effects in protecting long-term nutritional This paper-a product of the Poverty Team, Development Research Group-is part of a larger effort in the department to promote rigorous impact evaluations of anti-poverty programs. Policy Research Working Papers are also posted on the Web at http://econ.worldbank.org. The author may be contacted at egalasso@worldbank.org. outcomes (height for age z-scores and incidence of stunting) against an underlying negative trend in the absence of the program. Importantly, the effect of the program exhibits substantial heterogeneity: gains in nutritional outcomes are larger for more educated mothers and for villages with better infrastructure. The program enables the analysis to isolate responsiveness to information provision and disentangle the effect of knowledge in the education effect on nutritional outcomes. The results are suggestive of important complementarities among child care, maternal education, and community infrastructure.

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

“…Paternal nutritional status is both less studied and less strongly predictive of malnutrition in international literature [17]; its importance in determining stunting may be a unique feature of our study, which included a large set of matched fathers, or of this population. This contrasts with previous studies in Madagascar which have attributed malnutrition to behavioral factors, poor maternal education, and male sex [25,27–29], and to international literature emphasizing parental education and behaviors [13,19] and male sex [13,17,21] as risk factors for malnutrition. The lack of association with vaccination and supplementation in our study provides evidence that these factors, which may mediate the relationships between parental education, work, and nutrition [18,20], are less important in this population.…”

“…Environmental factors such as rural location predispose to malnutrition in this population, similar to international ones [13,17]. Interventions to address malnutrition in Madagascar, which have focused on parental education and supplemental feeding [26,27,30], may need to be augmented with earlier, household-level, and population-level interventions.…”

“…International aid projects have included semi-annual nutrition screening and vaccination days, behavior change communication, mass media initiatives, and Integrated Management of Childhood Illness (IMCI) implementation at local health centers [30,31]. Local NGO efforts have supported a community health worker program in which locally elected, paid community agents (Agent Communitaire, AC) monitor child weight and provide nutrition and breastfeeding advice to mothers, similar to child health programs in other countries [27]. One World Bank-supported randomized controlled trial is currently testing the effects of supplementation and parenting education [26].…”

Tackling the drivers of child undernutrition in developing countries: what works and how should interventions be designed?

“…Moreover, although maternal education targeted towards improving child-care practices has not always been effective on its own (19) , a study in Madagascar showed that it can be effective where participatory approaches are used, networks of women's groups are supportive and the quality of the child-care services delivered is improved by training local community nutrition workers (20) . But the pathways that can translate maternal education into improved child nutrition need to be further clarified.…”

Saving Lives: Evidence from a Conditional Food Supplementation Program

“…On conditional cash transfers: Attanasio et al (2005); on community nutrition programs: White and Masset (2007); Hossain et al (2005); Galasso and Umapathi (2009) ;Galasso, Umapathi, and Yau (2011);Alderman et al (2009); on early child development programs: Armecin et al (2006); Alderman (2007); Alderman et al (2006);Behrman, Cheng, and Todd (2004).…”