Impact of Deworming and Micronutrient Supplementation on Maternal and Child Nutritional status

1. Impact of Deworming and Micronutrient Supplementation on Maternal and Child Nutritional status End-linePreliminary Findingsfrom a Randomised Control Trial in North-West Bangladesh with NDP

2. Project activities • Economic Empowerment/ Livelihood component: • 1. Creating access to land • Land leasing • Promotion of share-cropping • 2. Vegetables production and consumption • 3. Cash support

3. Nutrition Component: • 1. Behaviour Change Communication • Cooking demonstration • IYCF messages – Group meeting • Hygiene and Sanitation • 2. Micronutrient supplements (MNS) • 3. Regular deworming

4. Total BHHs Excluded (n = 15) 1043 BHHs Intervention Group Control Group Baseline nutrition survey October 2010 Provision of supplements December 2010 Intervention Group Control Group After 6 months of supplementation Midline nutrition survey May-June 2011 After 12 months End-line survey December 2011 Control group will receive 3 months of supplementation Figure : Trial profile

5. Methodology: • Longitudinal Panel study • Cluster Randomised Trial • Mixed Method (Qualitative & Quantitative) • Sample size (Quantitative): • 1043 BHHs 537 Intervention 503 Control

6. OBJECTIVES • Quantitative Surveys: • Through the bi-annual surveys (midline and end-line surveys) the project aims to determine:- • intra-individual biannual change in nutritional status • Change in household food intake and food security status. • and, as such, the outcomes of the nutrition intervention package. • Qualitative Investigation: • Capture the lessons learned • Beneficiary perspectives • Management issues • Guidance for scaling up and future project planning

7. Data collected on: (Quantitative) • Socio-demography • Anthropometry • Blood Haemoglobin • Morbidity • Household Food Intake • Food Coping Mechanism (Food Security)

8. PreliminaryFindings from the End-line Survey

9. Compliance: • Sprinkles were taken and liked by everyone • It was seen as an ‘asset’, “the rich have meat and fish, and we have pushti’. • The control group wanted it. • Sharing pushti with other members of the family - The mothers admitted that about once a week they do this don’t share with husbands or much older kids – it’s seen as a women and kids item.

10. Household Food Intake Mean no of food items consumed Another way of measuring food diversity based on 7 food groups as defined by WHO/UNICEF

11. Households asked whether eaten 13 food items in the previous 7 days – provides a measure of food diversity

12. Improvement from survey 1 (6.42 foods) to 8.77 foods in survey 2 continued to 9.5 in survey 3

13. Measuring food diversity based on 7 food groups as defined by WHO/UNICEF Grains, roots and tubers, legumes and nuts, dairy products, flesh foods, eggs, vitamin A rich fruits and vegetables

14. HOUSEHOLD FOOD SECURITY Households asked about 10 food coping strategies

15. Mean Food Coping Strategy fell from 4.56 to 2.2

16. Maternal Nutritional Status • Anthropometry • Change in body weight • Change in Body Mass Index (BMI) • Chronic energy deficiency (CED) • Measured by BMI • Haemoglobin (Anaemia)

17. Mother’s Mean Haemoglobin concentration by HH head

18. Upward trend in blood heamoglobin concentration was found in both male and female headed households

20. Mother’s Mean Haemoglobin concentration in control and Intervvention group, after removing the effect of mother’s age and sex of the HH head

21. Change in Child (U-5) Nutritional Status • Anthropometry • Weight for Height (wasting) • Weight for Age (underweight) • Height for Age (stunting) • Haemoglobin (Anaemia)

22. Change in mean weight and height

23. Weight for Height Z-Scores (WHZ)

25. Height for Age Z-Scores (HAZ)

27. Weight for Age Z-Scores (WAZ)

29. Haemoglobin Concentration (Children-U5)

31. Before the intervention

32. After the intervention

33. Limitation of the study • No socio-economic information • Lack of detailed dietary data

34. THANKS

38. Methodology: (Mixed) • 1. Quantitative (Longitudinal trial) • Structured Questionnaire • Anthropometric and Hb Measurement

39. 2. Qualitative Investigation • Focus Group Discussions (BHHs) • In-depth Interviews • Interviews of project staff • And..... • 3. NDP’s • Monitoring • Data

40. ATTRITION Total attrition rate 11.31% - Information was collected on 927 mothers and 298 under 5 years old children.

41. COMPLIANCE

42. Household Food Intake MFC- increased from 6.41 to 8.77 MFD- increased from 4.44 to 5.01 Figure 2: Mean number of food types consumed by control and intervention group Figure 3: Mean food diversity by control and intervention group

43. animal protein consumption has improved significantly • meat and poultry consumption have increased from 3.3% and 6.6% to 13.5% and 23.7% respectively, • eggs (14.1% to 45.4%) • milk (21.7% to 58.3%) • dried fish (32.6% to 67.2%) • fresh fish (66.2% to 80.1%) • Green veg. 96.6% to 96.1% • Other veg. 82.0% to 98.8%

44. Household Food Security with a fall in mean number of coping strategies used from 4.56 to 3.77 Figure 4: Mean food coping strategy by control and intervention groups

45. Most beneficiaries consumed fish and egg maybe twice a month • That fish and egg was divided 3 or 4 ways among family members. Consuming more vegetables and slightly more rice than before, as they could sell the vegetables and purchase rice and also had 40 taka wage supplementation when they worked on their fields

46. Most families could afford about 50grams of cooking oil per week (i.e. very little). Only one even mentioned eating 100 gm of dal in a week.

47. Morbidity

50. Greater appetite was reported by all 6 groups. Their appetite increased after starting consuming vegetables and practicing hygiene, and rose further with taking the sprinkles. It was chiefly seen as a primarily function of reduced chronic ill-health Before the intervention they claimed that when working sometimes they felt they had to stop because of weakness, tingling, dizziness and fainting.