An evaluation of the impact of a US$60 million nutrition programme in Bangladesh.
OBJECTIVE
To compare levels of childhood malnutrition in areas where the Bangladesh Integrated Nutrition Project had been operational for over 5 years with matched non-project areas, with the purpose of evaluating whether the project had achieved its objective of reducing the prevalence of underweight among children <24 months.


METHODS
The study involved an ex-post cross-sectional survey in six thanas (a locality with a population of approximately 200,000-450,000 people) in Bangladesh. Participants were 6,820 households (4,554 in the project areas and 2,266 in the non-project areas) including 7183 children aged 6-59 months selected using a two-stage stratified cluster sampling frame. Main outcome measures were moderate and severe underweight, wasting and stunting reported using z scores, and indicators of mothers' reported nutritional knowledge and practice.


RESULTS
2,388 children aged 6-23 months and 6815 children aged 6-59 months had clean anthropometric data. No significant difference was found between the socio-economic variables of households in the project and non-project areas. No significant difference was found in the prevalence of either severe or moderate underweight (weight-for-age) in children aged 6-23 months in the project and non-project areas: 183 (11.4%, 95% confidence interval 9.9-13.2%) children in project areas and 96 (12.2%, 95% confidence interval 9.9-14.8%) children in non-project areas. Mothers in project areas reported significantly better caring practices than in non-project areas.


CONCLUSIONS
There is no evidence that the Bangladesh Integrated Nutrition Project has achieved its objectives to reduce severe underweight by 40% if project areas are compared ex-post with non-project areas. There is urgent need to review the evidence behind investments based on growth monitoring and promotion.
Hossain
S M Moazzem
SM
UNICEF, Islamabad, Pakistan.
Duffield
Arabella
A
Taylor
Anna
A
D001459:Bangladesh / Q000453:epidemiology; D001835:Body Weight; D002657:Child Development / Q000502:physiology; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D040361:Healthy People Programs / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D044342:Malnutrition / Q000453:epidemiology*; D009035:Mothers / Q000193:education; D018673:Nutrition Policy; D011247:Pregnancy; D015995:Prevalence