From research to program design

"This paper summarizes findings from a formative research study conducted in Haiti to develop a behavior change communication (BCC) strategy to improve infant and child feeding practices and to reduce childhood malnutrition. It describes the methodology used and the tools developed to facilitate decisionmaking and effective use of formative research for program planning... The study used formative research methods that included individual and group interviews, food-rating exercises, and participatory recipe trials. The aims of the study were to (1) study current infant and young child feeding practices in the Central Plateau of Haiti, (2) identify individual, household, and community factors that may facilitate or constrain adoption of recommended behaviors, and (3) use the information from the formative research to prioritize behaviors and design an effective BCC strategy." from Authors' Abstract

From research to program design

"This paper summarizes findings from a formative research study conducted in Haiti to develop a behavior change communication (BCC) strategy to improve infant and child feeding practices and to reduce childhood malnutrition. It describes the methodology used and the tools developed to facilitate decisionmaking and effective use of formative research for program planning... The study used formative research methods that included individual and group interviews, food-rating exercises, and participatory recipe trials. The aims of the study were to (1) study current infant and young child feeding practices in the Central Plateau of Haiti, (2) identify individual, household, and community factors that may facilitate or constrain adoption of recommended behaviors, and (3) use the information from the formative research to prioritize behaviors and design an effective BCC strategy." from Authors' Abstract

The use of operations research as a tool for monitoring and managing food-assisted maternal/child health nutrition (MCHN) programs: An Example from Haiti

"This report describes the methods and results of an operations research undertaken to assess the effectiveness of World Vision (WV)'s food assisted maternal and child health and nutrition (MCHN) program in the Central Plateau region of Haiti. The research had three main objectives: (1) to assess the effectiveness of implementation and operations of the program relative to plans; (2) to assess the quality of delivery of the various services; and (3) to explore the perceptions of different stakeholders (i.e., beneficiaries and field implementers) regarding program operations and service delivery and the motivational factors that may affect staff's performance and job satisfaction. The overall goal was to identify constraints to effective operations; it was more important to identify and implement corrective actions that will ensure smooth implementation of the program and its various components. The report is directed to program managers, researchers, and development professionals who are interested in applying operations research methods to evaluate and strengthen similar MCHN programs with a food aid component in developing countries." Authors' AbstractOperations research ,Nutrition programs ,Food aid ,Children Health and hygiene Haiti ,Maternal and infant welfare Developing countries ,Assessment ,

The use of operations research as a tool for monitoring and managing food-assisted maternal/child health nutrition (MCHN) programs

"This report describes the methods and results of an operations research undertaken to assess the effectiveness of World Vision (WV)'s food assisted maternal and child health and nutrition (MCHN) program in the Central Plateau region of Haiti. The research had three main objectives: (1) to assess the effectiveness of implementation and operations of the program relative to plans; (2) to assess the quality of delivery of the various services; and (3) to explore the perceptions of different stakeholders (i.e., beneficiaries and field implementers) regarding program operations and service delivery and the motivational factors that may affect staff's performance and job satisfaction. The overall goal was to identify constraints to effective operations; it was more important to identify and implement corrective actions that will ensure smooth implementation of the program and its various components. The report is directed to program managers, researchers, and development professionals who are interested in applying operations research methods to evaluate and strengthen similar MCHN programs with a food aid component in developing countries." Authors' AbstractOperations research ,Nutrition programs ,Food aid ,Children Health and hygiene Haiti ,Maternal and infant welfare Developing countries ,Assessment ,

Culture, environment, and food to prevent vitamin A deficiency

Published jointly by INFDC and IDRCCompanion volume to: Community assessment of natural food sources of vitamin A : guidelines for an ethnographic protoco

Towards a Multi-Dimensional Index of Child Growth to Combat the Double Burden of Malnutrition

Background: There is growing awareness in the field of public health that combatting the double burden of malnutrition requires approaches that address its multi-dimensional origin, rather than focusing primarily on the biomedical domain. Current frameworks of malnutrition like the UNICEF conceptual framework, and the Lancet Series 2013 framework have been instrumental in understanding the determinants of malnutrition and developing appropriate interventions. However, these frameworks fail to explicitly address issues of agency, that is, about being able to pursue one’s goal. The capability approach as originally developed by Amartya Sen includes agency in the causal chain.Summary and key Messages In the past 5 years, the International Union of Nutritional Sciences Task Force “Towards a multi-dimensional index for child growth and development” has developed a capability framework for child growth, and conducted empirical research applying this framework. The working group discussed what would be needed to further develop the approach and explained the added value to international organisations and policy makers. We suggest developing an index of advantage that will be a proxy for a child’s agency. We hypothesise that such an index will explain much of the variance in studying inequalities in child nutrition and thus call for action to improve this focal point

Community Participation and Multidimensional Child Growth:Evidence from the Vietnam Young Lives Study

BACKGOUND: Community participation has the potential to improve the effects of interventions and reduce inequalities in child growth. Multidimensional indicators capture such effects and inequalities. OBJECTIVES: The objective of this study was to measure the association between multidimensional child growth and community participation in 2 nutrition-sensitive interventions. METHODS: A Multidimensional Index of Child Growth was calculated with the 5-y-old cohort of the Vietnam Young Lives Survey. Young Lives is a unique dataset that has information on community participation in the design and implementation stages of 2 interventions: a health and a water, sanitation, and hygiene (WASH) intervention. Community participation during the interventions was recorded retrospectively with interviews at the household level. Ordinary least-squares and quantile regressions were estimated using data on 240 children. A Multidimensional Index of Child Advantage, sex, and location (urban/rural) were included as control covariates. RESULTS: A positive association (post hoc statistical power = 0.859) was estimated for community participation during the design stage of the WASH intervention, particularly for the most deprived children (P < 0.05). Negative effects were estimated for the health intervention during the design stage (P < 0.05) and no significant effects were found for community participation during the implementation stage of the interventions. Instead of the physical dimension, the significant associations in the design stage were related to the nonphysical dimension of child growth. Inequalities in multidimensional growth were found for children living in rural areas, but not for girls. CONCLUSIONS: The association between community participation and multidimensional child growth is indicative of the importance of community participation during the design phase of interventions, in particular for the nonphysical dimensions of child growth related to social and psychological factors. The benefits of participation were greater for urban children compared with rural children, which deserves further attention

Constraints and opportunities for implementing nutrition-specific, agricultural and market-based approaches to improve nutrient intake adequacy among infants and young children in two regions of rural Kenya.

Several types of interventions can be used to improve nutrient intake adequacy in infant and young child (IYC) diets, including fortified foods, home fortification, nutrition education and behaviour change communication (BCC) in addition to agricultural and market-based strategies. However, the appropriate selection of interventions depends on the social, cultural, physical and economic context of the population. Derived from two rural Kenyan populations, this analysis combined information from: (1) a quantitative analysis to derive a set of food-based recommendations (FBRs) to fill nutrient intake gaps in IYC diets and identify 'problem nutrients' for which intake gaps require solutions beyond currently available foods and dietary patterns, and (2) an ethnographic qualitative analysis to identify contextual factors posing opportunities or constraints to implementing the FBRs, including perceptions of cost, convenience, accessibility and appropriateness of the recommended foods for IYC diets and other social or physical factors that determine accessibility of those foods. Opportunities identified included BCC to increase the acceptability and utilisation of green leafy vegetables (GLV) and small fish and agronomic interventions to increase the productivity of GLV and millet. Value chains for millet, beans, GLV, milk and small fish should be studied for opportunities to increase their accessibility in local markets. Processor-level interventions, such as partially cooked fortified dry porridge mixes or unfortified cereal mixes incorporating millet and beans, may increase the accessibility of foods that provide increased amounts of the problem nutrients. Multi-sectoral actors and community stakeholders should be engaged to assess the feasibility of implementing these locally appropriate strategies

The role of care in nutrition programmes: current research and a research agenda

The importance of cultural and behavioural factors in children's nutrition, particularly with regard to feeding, has been recognized only recently. The combination of evidence regarding the importance of caregiving behaviour for good nutrition, and improved strategies for measuring behaviour have led to a renewed interest in care. The UNICEF conceptual framework suggests that care, in addition to food security and health care services, are critical for children's survival, growth and development. The present paper focuses on the care practice of complementary feeding, specifically behavioural factors such as parental interaction patterns, feeding style and adaptation of feeding to the child's motor abilities (self-feeding or feeding by others). Three kinds of feeding styles (Birch & Fisher, 1995) are identified: controlling; laissez-faire; responsive. Probable effects of each feeding style on nutrient intake are described. A number of studies of feeding behaviour have suggested that the laissez-faire style is most frequently observed among families and communities with a higher prevalence of malnourished children. Nutrition interventions that have been able to show significant effects on outcomes, such as the Hearth Model in Vietnam (Sternin et al. 1997), have usually incorporated behavioural components in their intervention. At this time, there have been no tests of the efficacy of behavioural interventions to improve feeding practices. Research is needed to understand behavioural factors in complementary feeding, and to identify and test intervention strategies designed to improve nutrient intake of young children. Finally, the paper concludes with a discussion of how nutrition programmes might change if care were incorporated