Abstract
BackgroundAlthough malnutrition particularly stunting is recognized as multi-causal, there has been limited integrated nutrition interventions to reduce its burden in children under-fives and those existing are not well evaluated. This study tested the effectiveness of provision of health and nutrition education and promotion of home gardening in child stunting.MethodsThe study used a quasi-experimental evaluation design. Two rounds of household surveys were done to assess changes in behaviors (uptake of Antenatal Care services and child feeding practices) and stunting among children under-5 years. The sample size was calculated to detect a 10% percent absolute baseline-to-end-line change in stunting. A two-stage stratified sampling process was used to sample 896 and 1736 households at each round of data collection in the intervention and control districts respectively. Mothers delivered in the past 24 months preceding the survey and all children under-5 years residing in selected households were eligible. The difference in difference (DID) analysis was used to estimate effect of the interventions. All ethical clearances were obtained from relevant authorities prior to data collection.ResultsA total of 3467 and 4145 children under 5 years were recruited at baseline and endline respectively. The proportional of stunted children decreases from 35.9 to 34.2% in intervention and from 29.3 to 26.8% in the control sites. Overall, no statistically significant stunting reduction was observed between intervention and control sites. However, a significant effect was observed in intermediate outcomes; Uptake of iron folic acid (DID: 5.2%, (95% CI: 1.7–8.7), p = 0.003), health facility delivery (DID: 6.5%, (95% CI: 1.8–11.2), p = 0.006), pre-lacteal feeding (DID: − 5.9%, (95%CI: − 9.2, − 2.5), p = 0.001), breast feeding within 1 h after birth (DID: 7.8%, (95%CI: 2.2–13.4), p = 0.006) and exclusive breast feeding in children under 6 months (DID:20.3%, (95% CI: 10.5–30.1), p = 0.001).ConclusionThe 3 years program did not result in significant evidence of stunting reduction, but the observed effect on health and nutrition behavioural indicators are at the causal pathways to improved child nutritional outcomes in the long run. Implementation of these integrated packages over a longer duration is needed to witness significant reduction in the prevalence of stunting.
Highlights
Malnutrition stunting is recognized as multi-causal, there has been limited integrated nutrition interventions to reduce its burden in children under-fives and those existing are not well evaluated
African continent is by far the hardest hit by stunting with 30 countries out of 41 ranked worldwide with highest number of people experiencing more than one form of malnutrition [2]
This study investigated the effectiveness of integrated intervention in the first 1000 days of a child’s life on reduction of child stunting
Summary
Malnutrition stunting is recognized as multi-causal, there has been limited integrated nutrition interventions to reduce its burden in children under-fives and those existing are not well evaluated. The world has observed positive progress in improvement of child and maternal health and nutrition indicators, levels of undernutrition, stunting, continue to be high with approximately 149 million children under-five were stunted in 2018 [1]. Disparities exists between regions with six regions (Ruvuma, Iringa, Rukwa, Kigoma, Njombe and Songwe) out of 26 having over 40% of stunted children [6]. This is unacceptably high by the WHO standards [7]. The 2015/2016 Demographic and Health Survey indicates, one in ten women aged 15–49 years were either underweight or obese and 18% were overweight [6]. 45% of women of reproductive age and 57% of pregnant women were anemic [6]
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