Evaluation of Programs to Improve Complementary Feeding in Infants and Young Children

Evaluation of complementary feeding programs is needed to enhance knowledge on what works,to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs,presenting concepts and methods and illustrating them through examples. Planning and investments for eval-uations should occur from the beginning of the project life cycle. Essential to evaluation is articu-lation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit the dynamic connections in the program theory and accounts for contextual factors that could influence program effectiveness.Evaluating implementation functioning is done through addressing questions about needs, cover-age, provision, and utilization using information obtained from process evaluation, operations research, and monitoring. Evaluating effectiveness is done through assessing impact, efficiency,coverage, process, and causality. Plausibility designs ask whether the program seemed to have an effect above and beyond external influences, often using a nonrandomized control group and baseline and end line measures. Probability designs ask whether there was an effect using a randomized control group. Evaluations may not be able to use randomization, particularly for pro-grams implemented at a large scale. Plausibility designs, innovative designs, or innovative combina-tions of designs sometimes are best able to provide useful information. Further work is needed to develop practical designs for evaluation of large‐scale country programs on complementary feeding

Poverty, Food Insecurity and Nutritional Deprivation in Rural China: Implications for Children\u27s Literacy Achievement

Globally, food insecurity is a significant contextual aspect of childhood. About 850 million people were undernourished worldwide during the period 2006 to 2008, including 129.6 million people, or 10 percent of the population, in China (FAO 2011:45‐46). Implications of food insecurity for children\u27s schooling in developing country contexts are poorly understood. Analyses of a survey of children from 100 villages in northwest China show that long‐term undernourishment and food insecurity strike the poorest disproportionately, but not exclusively; long‐term undernourishment matters for literacy via early achievement; and, after adjusting for socioeconomic status, long‐term undernourishment, and prior achievement, food insecure children have significantly lower literacy scores

Food insecurity and subsequent weight gain in women

Objective: Cross-sectional data indicate that a relationship between household food insecurity and overweight exists among women in the USA. Cross-sectional data cannot determine if food insecurity leads to overweight as some have hypothesised. The purpose of the present study was to examine the relationship of food insecurity with subsequent weight gain in women using data from the Panel Study of Income Dynamics (PSID). Design, setting and subjects:Panel data from the 1999 and 2001 PSID, a nationally representative sample of households, were analysed using multivariate regression procedures. Results: Average weight gain among all women (n=5595) was 1.1 kg on average over the two years. There were no significant differences in the percentages of women who gained a clinically significant amount (2.3kg) by food insecurity status. Overweight women who were on a weight-gain trajectory during the 2-year period gained less if they were food-insecure. This relationship was not observed among healthy-weight or obese women. Conclusions: Overall, food insecurity does not appear to be strongly associated with subsequent weight gain in women

Agricultural and Finance Intervention Increased Dietary Intake and Weight of Children Living in HIV-Affected Households in Western Kenya.

We tested whether a multisectoral household agricultural and finance intervention increased the dietary intake and improved the nutritional status of HIV-affected children. Two hospitals in rural Kenya were randomly assigned to be either the intervention or the control arm. The intervention comprised a human-powered water pump, microfinance loan for farm commodities, and training in sustainable farming practices and financial management. In each arm, 100 children (0-59 mo of age) were enrolled from households with HIV-infected adults 18-49 y old. Children were assessed beginning in April 2012 and every 3 mo for 1 y for dietary intake and anthropometry. Children in the intervention arm had a larger increase in weight (β: 0.025 kg/mo, P = 0.030), overall frequency of food consumption (β: 0.610 times · wk-1 · mo-1, P = 0.048), and intakes of staples (β: 0.222, P = 0.024), fruits and vegetables (β: 0.425, P = 0.005), meat (β: 0.074, P < 0.001), and fat (β: 0.057, P = 0.041). Livelihood interventions have potential to improve the nutrition of HIV-affected children. This trial was registered at clinicaltrials.gov as NCT01548599

Before the Lunch Line: Effectiveness of Behavioral Economic Interventions for Pre-Commitment on Elementary School Children’s Food Choices

In this study, we intervened in elementary schools on lunch entrée selection using some of the behavioral economic methods shown to be effective in earlier food choice studies. Unlike many earlier behavioral interventions, which were mostly done in controlled environments and smaller café type settings for one-off interactions, we conducted our interventions in a real-world environment in twelve elementary schools in one school district in South Carolina over nine school weeks. By increasing salience and prominence of the healthy entrée of the day through visual and verbal tools, we nudged students towards selecting healthier options in treatment schools. We estimated the treatment effects using a difference-in-differences setup, comparing changes in the share of students selecting nudged entrées during the treatment period relative to the shares before the treatment period in treatment and comparison schools. Our estimates show that the nudges are effective when present. They increase selection of the healthy option by thirteen to thirty-five percent on the days the entrée is treated. Effects disappear when the nudge is removed, however, and there is evidence for reduced effectiveness of nudges in repeat instances. There is no evidence of habit formation

Before the Lunch Line: Effectiveness of Behavioral Economic Interventions for Pre-Commitment on Elementary School Children’s Food Choices

In this study, we intervened in elementary schools on lunch entrée selection using some of the behavioral economic methods shown to be effective in earlier food choice studies. Unlike many earlier behavioral interventions, which were mostly done in controlled environments and smaller café type settings for one-off interactions, we conducted our interventions in a real-world environment in twelve elementary schools in one school district in South Carolina over nine school weeks. By increasing salience and prominence of the healthy entrée of the day through visual and verbal tools, we nudged students towards selecting healthier options in treatment schools. We estimated the treatment effects using a difference-in-differences setup, comparing changes in the share of students selecting nudged entrées during the treatment period relative to the shares before the treatment period in treatment and comparison schools. Our estimates show that the nudges are effective when present. They increase selection of the healthy option by thirteen to thirty-five percent on the days the entrée is treated. Effects disappear when the nudge is removed, however, and there is evidence for reduced effectiveness of nudges in repeat instances. There is no evidence of habit formation

Household Water Insecurity Is Positively Associated With Household Food Insecurity in Low- and Middle-Income Countries

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Is Malnutrition Declining? an Analysis of Changes in Levels of Childhood Malnutrition Since 1980

Nutritional status is the best global indicator of well-being in children. Although many surveys of children have been conducted since the 1970s, lack of comparability between them has made it difficult to monitor trends in child malnutrition. Cross-sectional data from 241 nationally representative surveys were analysed in a standard way to produce comparable results of low height-for-age (stunting). Multilevel modelling was applied to estimate regional and global trends from 1980 to 2005. The prevalence of stunting has fallen in developing countries from 47% in 1980 to 33% in 2000 (i.e. by 40 million), although progress has been uneven according to regions. Stunting has increased in Eastern Africa, but decreased in South-eastern Asia, South-central Asia and South America; Northern Africa and the Caribbean show modest improvement; and Western Africa and Central America present very little progress. Despite an overall decrease of stunting in developing countries, child malnutrition still remains a major public health problem in these countries. In some countries rates of stunting are rising, while in many others they remain disturbingly high. The data we have presented provide a baseline for assessing progress and help identify countries and regions in need of population wide interventions. Approaches to lower child malnutrition should be based on successful nutrition programmes and policies