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

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

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

Estimates of the Quality of Complementary Feeding Amongvietnamese Infants Aged 6-23months Varied by Howcommercial Baby Cereals Were Classified in 24-H Recalls

The World Health Organization\u27s (WHO) standardized questionnaire for assessing infant and young child feeding practices does not include commercial baby cereals (CBC), which are derived from several food groups and are fortified with micronutrients. We examined how different scenarios for classifying CBC affect estimates of the quality of complementary feeding in children ages 6−23 months in Vietnam in 2014 (n = 4811). In addition to the WHO standardized 24‐h recall questionnaire for infant and young child feeding, we asked mothers about the consumption of CBC. The five resulting scenarios were S1 – omitted CBC; S2 – CBC classified as grains; S3 – as grains and dairy; S4 – as grains, dairy and fruit/vegetables; and S5 – as grains, dairy, fruit/vegetables and any others. Including CBC resulted in 4−11 percentage points higher in the prevalence of children who were fed each of the six food groups compared with what was reported in the WHO standardized questionnaire. Minimum dietary diversity (% fed ≥ 4 out of the 7 food groups) was higher in S5 (90%) than in S1 (84%), S2 (84%), S3 (85%) and S4 (86%). Minimum acceptable diet was also higher in scenarios S5 (80%) than in S1 (74%), S2 (75%), S3 (75%) and S4 (77%). Consumption of iron‐rich foods was 94% when CBC was accounted, which was higher than the alternative scenario (89%). In summary, when CBC were included, population‐level estimates of dietary quality were higher than when CBC were omitted. Guidance is required from the WHO about how to account for the consumption of CBC when estimating the quality of complementary feeding

Using Height-For-Age Differences (HAD) Instead of Height-For-Age Z-Scores (HAZ) for the Meaningful Measurement of Population-Level Catch-Up in Linear Growth in Children Less Than 5 Years of Age

Background: Evidence from studies conducted in nutritionally deprived children in low- and middle-income countries (LIMC) in past decades showed little or no population-level catch-up in linear growth (mostly defined as reductions in the absolute height deficit) after 2 years of age. Recent studies, however, have reported population-level catch-up growth in children, defined as positive changes in mean height-for-age z-scores (HAZ). The aim of this paper was to assess whether population-level catch-up in linear growth is found when height-for-age difference (HAD: child’s height compared to standard, expressed in centimeters) is used instead of HAZ. Our premise is that HAZ is inappropriate to measure changes in linear growth over time because they are constructed using standard deviations from cross-sectional data. Methods: We compare changes in growth in populations of children between 2 and 5 years using HAD vs. HAZ using cross-sectional data from 6 Demographic and Health Surveys (DHS) and longitudinal data from the Young Lives and the Consortium on Health-Orientated Research in Transitional Societies (COHORTS) studies. Results: Using HAD, we find not only an absence of population-level catch-up in linear growth, but a continued deterioration reflected in a decrease in mean HAD between 2 and 5 years; by contrast, HAZ shows either no change (DHS surveys) or an improvement in mean HAZ (some of the longitudinal data). Population-level growth velocity was also lower than expected (based on standards) in all four Young Lives data sets, confirming the absence of catch-up growth in height. Discussion: We show no evidence of population-level catch-up in linear growth in children between 2 to 5 years of age when using HAD (a measure more appropriate than HAZ to document changes as populations of children age), but a continued deterioration reflected in a decrease in mean HAD. Conclusions: The continued widening of the absolute height deficit after 2 years of age does not challenge the critical importance of investing in improving nutrition during the first 1000 days (i.e., from conception to 2 years of age), but raises a number of research questions including how to prevent continued deterioration and what is the potential of children to benefit from nutrition interventions after 2 years of age. Preventing, rather than reversing linear growth retardation remains the priority for reducing the global burden of malnutritionworldwide