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Assessing the impact on child nutrition of Ethiopia’s Community-based Nutrition (CBN) Program
- 1. Assessing the impact of Ethiopia’s Community-based Nutrition programme on child nutrition Conducted by: Tulane University Department of Global Community Health and Behavioural Sciences School of Public Health and Tropical Medicine
- 2. Community-based Nutrition (CBN) Conducted by Volunteer Community Health Workers (VCHWs), supported by Health Extension Workers (HEWs) • Growth monitoring and promotion (GMP) • Monthly community conversations • Home follow up visits for growth faltering, sick children • Health post referral for sick and/or malnourished children • Community engagement via informal contact
- 3. CBN: expansion and scale-up • Covered rural woredas in four agrarian regions: Amhara, Oromia, SNNPR and Tigray • Launched in tranches, by groups of woredas • Present in 228 woredas by 2012, implemented in four tranches
- 4. CBN Routine Data TR 2 Baseline TR 3 Baseline Midline .
- 5. CBN evaluation Objectives • Assess plausible attribution of changes in anthropometry to CBN activities • Assess trends in knowledge and practice of good nutrition behaviours • Describe programme implementation using process indicators Methods • Four sample surveys conducted following tranches 2 and 3 • Covered ~60 clusters (census enumeration areas) • Resampled households within clusters at baseline and midline • Establishment of ‘control’ groups was not possible • Internal comparison possible due to varying degrees of implementation
- 6. CBN evaluation: anthropometric changes 0% 10% 20% 30% 40% 50% 60% 2008 2009 2010 2011 2012 Change in stunting and severe stunting prevalence between baseline and midline (solid line), compared to expected stunting trend based upon DHS historical data (dashed line, beginning at baseline estimate from evaluation survey), in TRANCHE 2 Stunting Prevalence Expected Stunting Trend Severe Stunting Prevalence Expected Severe Stunting Trend DHS 2011 Stunting Prevalence
- 7. CBN evaluation: contact with HEWs and VCHWs
- 8. CBN evaluation: change in IYCF indicators
- 9. CBN evaluation: conclusions • Potential for impact on both important process indicators and anthropometric outcomes • Intensity of community contact likely very important for association of programme with outcomes • Participation of 30% suggested need for focus on increasing as programme expanded
- 10. Future direction • What is the impact of change from community level activity (VCHWs) to facility (health post) delivery (HEWs)? • Coverage has increased dramatically, but how can the quality of interventions be ensured? Especially the ‘promotion’ component? Reference: White, J., Mason, J. Assessing the impact on child nutrition of the Ethiopia Community-based Nutrition Program. Report to UNICEF of an evaluation study. Tulane University School of Public Health and Tropical Medicine, New Orleans. September, 2012.
Editor's Notes
- Began in 2008 - As part of the NNP: community based preventative services delivered at community level to improve nutritional status of children and mothers Services delivered at community level by VCHWs
- Evaluation commissioned by the Government of Ethiopia with support of UNICEF Implementation: determined by 1) CBN reporting and 2) differences in VCHW activity (tranche 2 only)
- Participation in programme was approximately 30% Association of change in stunting with programme implementation remained significant in regression analyses controlling for potential confounders (SES, education, sanitation access)
- Select process indicators – describes programme, intensity Ratio of community workers to children vital to impact