Evidence from two cluster-randomized control trials in Bangladesh
Chronic under-nutrition is widespread in many low‐income countries, including in Bangladesh, where 36% of children under 5 years old are stunted. Inadequate infant and young child nutrition (IYCN) knowledge and practices lead to poorer preschool nutrition outcomes, and subsequently, to poorer health, education, and labor outcomes in adulthood.
Behavior change communication (BCC) can improve infant and young child nutrition knowledge, practices, and health outcomes. However, few studies have examined whether the improved knowledge persists after BCC activities end. The new paper by John Hoddinott, Akhter Ahmed, Naureen I. Karachiwalla, and Shalini Roy just published in Maternal and Child Nutrition assesses the effect of nutrition sensitive social protection interventions on IYCN knowledge in rural Bangladesh, both during and after intervention activities.
There are 3 main findings: First, the BCC improves IYCN knowledge substantially in the 1st year of the intervention; participants correctly answer 3.0–3.2 more questions (36% more) compared to the non‐BCC groups. Second, the increase in knowledge between the 1st and 2nd year was smaller, an additional 0.7–0.9 correct answers. Third, knowledge persists; there are no significant decreases in IYCN knowledge 6–10 months after nutrition BCC activities ended.
The core finding of the study that knowledge gained through nutrition BCC is retained after the BCC ends has a few important implications. It suggests that the costs of well-implemented, intensive BCC can be justified by the long-term effects, and that children born post-intervention may well benefit from their mothers' improved IYCN knowledge. This also means that studies measuring impact of such programs may underestimate their actual effectiveness if they fail to account for this persistence of impacts.
Hoddinott, John F.; Ahmed, Akhter; Karachiwalla, Naureen; and Roy, Shalini. Nutrition behaviour change communication causes sustained effects on IYCN knowledge in two cluster-randomised trials in Bangladesh. Maternal and Child Nutrition. Article in Press. First published online August 7, 2017: https://doi.org/10.1111/mcn.12498