Creating a child feeding index using the demographic and health surveys

Data from the Demographic and Health Surveys (DHS) for five Latin American countries (seven data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age (HAZ). Urban/rural differences were also examined...The data sets used were Bolivia, 1994 and 1998; Colombia, 1995; Guatemala, 1995 and 1999; Nicaragua, 1998; and Peru, 1996...This work shows that the data available in DHS data sets can be used for a variety of purposes, including to (1) describe and study the distribution of specific feeding practices by geographic area, or other characteristics of interest such as maternal schooling or household socioeconomic status; (2) create a child feeding index to quantify and illustrate associations between child feeding practices and child outcomes, thereby serving as an advocacy tool; and (3) identify practices and vulnerable groups that could be targeted by programs and policies to improve child feeding practices and overall child health and nutrition. In sum, greater use of the DHS data on child feeding practices should be promoted for research and analysis, as a source of guidance on program design and planning, and for advocacy.FCND ,Demography Latin America. ,Surveys Statistical methods. ,Health status indicators. ,Bolivia. ,Colombia. ,Guatemala. ,Nicaragua. ,Peru. ,Child Feeding. ,Children Growth. ,

Creating a child feeding index using the demographic and health surveys

Data from the Demographic and Health Surveys (DHS) for five Latin American countries (seven data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age (HAZ). Urban/rural differences were also examined...The data sets used were Bolivia, 1994 and 1998; Colombia, 1995; Guatemala, 1995 and 1999; Nicaragua, 1998; and Peru, 1996...This work shows that the data available in DHS data sets can be used for a variety of purposes, including to (1) describe and study the distribution of specific feeding practices by geographic area, or other characteristics of interest such as maternal schooling or household socioeconomic status; (2) create a child feeding index to quantify and illustrate associations between child feeding practices and child outcomes, thereby serving as an advocacy tool; and (3) identify practices and vulnerable groups that could be targeted by programs and policies to improve child feeding practices and overall child health and nutrition. In sum, greater use of the DHS data on child feeding practices should be promoted for research and analysis, as a source of guidance on program design and planning, and for advocacy.FCND ,Demography Latin America. ,Surveys Statistical methods. ,Health status indicators. ,Bolivia. ,Colombia. ,Guatemala. ,Nicaragua. ,Peru. ,Child Feeding. ,Children Growth. ,

Socio-economic differentials in child stunting are consistently larger in urban than rural areas

Urban-rural comparisons of childhood undernutrition suggest that urban populations are better-off than rural populations. However, these comparisons could mask the large differentials that exist among socioeconomic groups in urban areas. Data from the Demographic and Health Surveys (DHS) for 11 countries from three regions were used to test the hypothesis that intra-urban differentials in child stunting were greater than intra-rural differentials, and that the prevalence of stunting among the urban and the rural poor was equally high. A socioeconomic status (SES) index based on household assets, housing quality, and availability of services was created separately for rural and urban areas of each country, using principal components analysis. In most countries, stunting in the poorest urban quintile was almost on par with that of poor rural dwellers. Thus, malnutrition in urban areas continues to be of concern, and effective targeting of nutrition programs to the poorest segments of the urban population will be critical to their success and cost-effectiveness.Malnutrition in children. ,Growth. ,Urban health. ,Rural health. ,

Socio-economic differentials in child stunting are consistently larger in urban than rural areas

Urban-rural comparisons of childhood undernutrition suggest that urban populations are better-off than rural populations. However, these comparisons could mask the large differentials that exist among socioeconomic groups in urban areas. Data from the Demographic and Health Surveys (DHS) for 11 countries from three regions were used to test the hypothesis that intra-urban differentials in child stunting were greater than intra-rural differentials, and that the prevalence of stunting among the urban and the rural poor was equally high. A socioeconomic status (SES) index based on household assets, housing quality, and availability of services was created separately for rural and urban areas of each country, using principal components analysis. In most countries, stunting in the poorest urban quintile was almost on par with that of poor rural dwellers. Thus, malnutrition in urban areas continues to be of concern, and effective targeting of nutrition programs to the poorest segments of the urban population will be critical to their success and cost-effectiveness.Malnutrition in children. ,Growth. ,Urban health. ,Rural health. ,

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 ,

Can young children's nutritional needs be met with a combination of fortified blended foods and local foods?

"Fortified donated cereal blends can greatly contribute to improving the nutritional quality of complementary foods, but are not sufficient to completely close the iron and zinc gaps at current fortification levels in Haiti, even when combined with locally available foods." from Text

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 ,

How do programs work to improve child nutrition?: Program impact pathways of three nongovernmental organization intervention projects in the Peruvian highlands

This paper examines the program logic of three nongovernmental, community-based programs with different intervention models to reduce childhood stunting. Two programs, Child Nutrition Program (PNI) and Good Start, focused directly on education and behavior change among caregivers, or the short routes to achieve impact, while one program, Sustainable Networks for Food Security (REDESA), focused on upstream factors, such as improving local governance and coordination, improving water and sanitation, and increasing family incomes, or the long routes to achieve impact. We compared the logic of each program as it was explicitly documented to the logic as perceived by the implementers. We elucidated the program impact pathways (PIPs) of key activities by actors at different operational levels in each program to identify congruencies and gaps in the perceptions of causal mechanisms between program activities and their intended outcomes, and analyzed them with the simple program models and logical frameworks to highlight the methodology and utility of PIPs. In a desire to move beyond static input-out models of the three programs, we designed and conducted data collection activities (document review, semi-structured interviews, and observations) with the intention of gaining insights about those aspects of the program that brought causal mechanisms of a given program into clearer focus. We propose that different methods for eliciting PIPs may be necessary at different operational levels. The interview method elicited more complete responses among those who are familiar with programmatic concepts, whereas actors at the local operational level provided sparse and fragmentary responses, even when simple, common language was used during the interviews. Group participatory processes, using visual aids, may be more effective for mapping the perceptions of those who are not accustomed to articulating information about programs. To reduce the length and frequency of interviews with program actors, initial PIPs could also be constructed from program documents, then discussed and revised iteratively with program actors. Although program logic models and the logical frameworks provide a succinct overview of the program (for communication, strategic planning, and management), we found that PIPs provide a better representation of the causal connections between program activities and results, particularly when both upstream and direct intervention activities were part of the same program. PIPs provide a visual tool for tracking how activities were perceived to work and make an impact, bringing into focus the different pathways of the activities and influences along the way. Beyond the logical sequence of program inputs, outputs, and outcomes, the conceptualization of impact pathways is a useful approach for understanding the causal connections required for impact and for identifying where attention and reinforcements may be required within program operation. The utility of this tool warrants its use not only during final evaluation but also during mid-program monitoring and relevant assessments. National- and regional-level program actors had good understanding of the overarching frameworks and principles of their respective programs as well as the program components and activities. They demonstrated a strong coherence to the program documents, provided similar cohesive responses, and were able to articulate the impact pathways. However, program actors at the national level identified fewer facilitators and barriers along the impact pathways than did the local actors, revealing that the practical dimensions of the impact pathways were not as evident to planners and managers farther from the communities. Although program actors at the local level were more apt to provide practical examples of influencing factors or incidents that occur during implementation, they had difficulty fully articulating their perceived PIPs and provided fragmented views of how the activities linked to their outcomes. Similar patterns were found across the three programs. This finding raises the question of desirability of a common understanding of the goals and pathways by which these outcomes are achieved or the acceptability of diversity of perspectives. It is still unclear whether program effectiveness may be improved through greater congruency in the PIPs. Future research should elucidate how congruency of PIPs among program actors across operational levels could be increased, and whether greater congruency would improve program implementation and effectiveness.program impact pathway, program logic model, logical framework, childhood stunting, child nutrition programs,