Impact evaluation of a community nutrition and livelihood program on child nutrition in rural Bangladesh.

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.

Adaptive Implementation of a Community Nutrition and Asset Transfer Program during the COVID-19 Pandemic in Rural Bangladesh.

Background: Reduced health and nutrition services as a result of coronavirus disease 2019 (COVID-19) measures endanger children's well-being. The Bangladesh Rajshahi Division of Maternal and Child Nutrition (BRDMCN; 2018-2020) involving social behavior change communication (SBCC) and an economic development (ED) of asset transfer was implemented. Objectives: This study describes how the implementation modality of the BRDMCN was adapted, and changes in the program's short/intermediate-term outcomes during the COVID-19 pandemic compared with pre-pandemic. Methods: The following evaluation components were assessed: 1) program fidelity, 2) program reach, 3) program acceptance, 4) perceived influence of COVID-19, and 5) short-term outcomes over the 3 y. We compared the first 2 y ("pre-COVID-19," from April 2018 through December 2019) and the final year ("during COVID-19," from January to December 2020) for all components except for (3) and (4). Data were collected through multiple sources: reviews of program annual progress reports, monitoring records of SBCC and ED programs, and cohort surveys (n = 1094). Results: The percentage dose delivery of activities decreased from 66.7-118% at pre-COVID-19 to 0-90% during COVID-19. The SBCC programs were altered to reduce the frequency of activities as well as the number of participants per session. The ED program involving large group meetings was modified to include within-member meetings, individual visits of community facilitators, or virtual discussions. Production activity using received assets continued during the pandemic, with no significant reduction compared with pre-COVID-19. The percentage of children recovering from underweight after 30 d of a Positive deviance/Hearth (PD/Hearth) session, a component of the SBCC program, remained constant at 16.5-20.3 percentage points before and during the COVID-19 pandemic. Conclusions: Program activities were scaled back and changed due to the pandemic. The BRDMCN maintained asset management and the degree of short-term outcomes over the course of a 3-y project. Further study is required to determine whether adaptive program management would achieve the long-term expected impact at a population level.

Impact of a livelihood promotion program on income generation and food consumption among ultra-poor households in rural Bangladesh.

BACKGROUND: Bangladesh has achieved notable economic progress in recent decades while economic inequality increased. Special attention is warranted on the ultra-poor population of the country. An 18 month-long economic development program, designed based on an ultra-poor graduation approach, was implemented to alleviate poverty and improve child nutrition in rural Bangladesh. OBJECTIVE: The study examined the impact of livelihood components of an economic development program on outcomes related to poultry/crop production, consumption, and income generation among the ultra-poor throughout quarterly follow-ups. METHODS: This secondary data analysis used the monitoring records of 2960 poor or ultra-poor households receiving assets of (1) 9-26 ducks (n = 2125), (2) 11 chickens (n = 872), and/or (3) vegetable seeds (n = 2407). Data measuring the production of assets, income generation, and consumption of assets were collected quarterly throughout 2019. To examine a one-year-long trend in participation, production, income generation, and consumption of assets, a one-way analysis of variance was conducted across the follow-ups. Additional analyses of annual income and consumption comparing duck and chicken groups were performed using linear regression models. RESULTS: The number of poultry assets per household decreased between the April- June and July-Sep follow-ups, while consumption of poultry and vegetable assets increased during the monsoon season (p < 0.001 for all). The vegetable production reflected seasonal fluctuations, where the lowest production and income were reported during the monsoon and pre-monsoon seasons. We observed increasing voluntary adoption of poultry farming among the non-asset group for both duck and chicken over the follow-ups (p < 0.001 for all). The households provided with duck assets gained a greater mean annual income compared to the households provided with chicken assets. CONCLUSIONS: Our findings highlight opportunities for strengthening the ultra-poor graduation approach on livelihood promotion in future scale-up in rural Bangladesh.

Age differences in the impact of a Positive Deviance/Hearth programme on the nutritional status of children in rural Bangladesh.

OBJECTIVE: To examine the difference in the rehabilitation rate from underweight by child age at enrolment in the Positive Deviance (PD)/Hearth programme. DESIGN: This secondary data analysis used programme monitoring records of underweight children aged 6-60 months attending a 2-week PD/Hearth session and followed up for 6 months from September 2018 to March 2019. Data were analysed using multilevel mixed-effect regression and Poisson regression with robust variance. SETTING: Rajshahi Division, Bangladesh. PARTICIPANTS: A total of 5227 underweight (weight-for-age Z-score (WAZ) <-2) children attended the PD/Hearth sessions. RESULTS: From enrolment to 6 months follow-up, the mean WAZ improved from -2·80 to -2·09, and the percentage of underweight children decreased to 54·5 %. Compared to the enrolment age of 6-11 months, the estimated monthly change in WAZ at 6 months of follow-up were 0·05 lower for 12-23 months, 0·06 lower for 24-35 months, and 0·09 lower for 36-60 months of the enrolment age (all P < 0·001). The probability of rehabilitation at 6 months of follow-up were lower by 16·7 % for 12-23 months (RR = 0·83; 95 % CI 0·77, 0·91), 15·5 % for 24-35 months (RR = 0·84; 95 % CI 0·78, 0·92), and 34·9 % for 36-60 months of the enrolment age (RR = 0·65; 95 % CI 0·59, 0·72), compared to the enrolment age of 6-11 months. CONCLUSIONS: Enrolment in the PD/Hearth programme at a younger age had the advantage of greater rehabilitation from underweight than older age. Our findings provide a better understanding of the successes and failures of the PD/Hearth programme to achieve more sustainable and cost-effective impacts.