Stunting – C4D Network

Desk review and SBCC roadmap on maternal, infant, and young child nutrition (MIYCN) and nutrition-sensitive practices in Indonesia (Alive & Thrive, 2019)

May 3, 2019

Alive & Thrive (A&T) researchers conducted an extensive desk review on maternal, infant, and young child nutrition (MIYCN) and nutrition-sensitive practices in Indonesia. The effort was aimed at supporting a national social and behavior change communication (SBCC) strategy as part of the Government of Indonesia’s National Stunting Reduction Movement.

A&T and key stakeholders—including UNICEF Indonesia, IMA World Health, Millennium Challenge Account Indonesia and The World Bank—continued to support the National Stunting Reduction Movement by using evidence from the desk review and other sources to develop a roadmap toward an SBCC strategy.

Click here for full details and access to both the desk review and the roadmap.

Engaging Community Members to Adopt Effective WASH Practices for Nutrition (SPRING brief, 2017)

February 18, 2019

The first 1,000 days, the period from pregnancy to two years of age, are critical for early childhood development. During this time, children are especially vulnerable to stunting, an irreversible condition that can result in lifelong cognitive and physical deficits. In 2011, stunting, or low height-for-age, affected more than 165 million children worldwide (Black et al. 2013). Mounting evidence indicates that poor water, sanitation, and hygiene (WASH) practices contribute significantly to stunting. Improving WASH practices reduces diarrheal disease, environmental enteric
dysfunction, and soil-transmitted helminth (parasitic worm) infections. Combined, these reductions contribute to decreases in stunting.

In Ghana, stunting is a particularly serious challenge. According to the 2014 Ghana Demographic and Health Survey (GDHS), 19 percent of Ghanaian children under the age of 5 are stunted. Among the regions with the highest rates of stunting is the Northern Region, where the prevalence is 33 percent (GDHS 2014). WASH practices in many parts of the country contribute to this problem. The majority of households (93 percent) do not treat their drinking water by any method (GDHS 2014), while only 14 percent use an improved toilet facility that is not shared with other
households (GDHS 2014). In the two weeks preceding the 2014 GDHS survey, the overall rate of diarrhea reported among children under five was 12 percent, a figure which tends to vary seasonally.

The SPRING project is a seven-year USAID-funded cooperative agreement to strengthen global and country efforts to scale up high-impact nutrition practices and policies and improve maternal and child nutrition outcomes. SPRING has worked for three years in Ghana, where USAID has tasked it with helping to prevent stunting and reduce anemia in the Feed the Future Zone of Influence in 15 districts in the Upper East and Northern Regions.

SPRING’s “WASH 1,000” strategy promotes focused, evidence-based WASH behaviors to eliminate common fecal-oral contamination pathways in children during the first 1,000 days. The strategy takes an integrated, multi-sectoral approach, simultaneously delivering products, services, and information to households with pregnant and lactating women and those with children under two (i.e., 1,000-day households).

Click here for full brief.

The Power of People-Centered Nutrition Interventions (Chapter 4.2 of Good Nutrition: Perspectives for the 21st Century, Karger e-book, 2016)

April 7, 2018

The process of understanding nutrition related problems, and of developing appropriate solutions – i.e., design thinking – can be quite challenging. In fact, there are far more examples of public health solutions that ignore the end-user than of ones that are built with the end-user in mind. For this very reason, the goal of this chapter is to convey the relevance of people-centered design to nutrition interventions, and to share some strategies for putting people at the heart of nutrition interventions.

The chapter uses case studies to consider the role of participatory photography, and grandmothers and indigenous knowledge systems in nutrition interventions.

Click here for full chapter.

Dial ‘N’ for Nutrition? A Landscape Analysis of What We Know About m-Nutrition, m-Agriculture and m-Development (IDS Working Paper 481, 2017)

March 3, 2018

Child undernutrition is one of the most devastating realities in many parts of the world. Globally in 2015, 159 million children below the age of five years were too short for their age (stunted) and 50 million were too thin for their height (wasted). Inadequate nutrition in early childhood can have lifelong consequences, including poor physical and psychological health, and low educational attainment and employment opportunities.

Behaviour change of child carers is central to the effectiveness of many interventions addressing child undernutrition. For example, early and exclusive breastfeeding and the complementary feeding of infants between six and 23 months requires changes in feeding, caring and playing with children, as well as changes in the types and frequency of foods consumed and their preparation.

Agriculture is probably the sector with the most studies on the effectiveness of nutrition-sensitive interventions. For agriculture to become more nutrition sensitive, choices will need to be made about who controls resources, which crops and animals are farmed, the types of storage and processing patterns adopted, and the metrics used to assess interventions. All of these changes are embedded in long cultural traditions and are not necessarily straightforward to change.

The purpose of this paper is to assist would-be implementers and evaluators to understand the landscape they are operating in, so they can design nutrition and agriculture interventions that stand the greatest chance of working, and evaluation designs that stand the greatest chance of finding answers rigorously.

Click here for full paper.

Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia: Findings from a Systematic Literature Review (SPRING 2014)

March 17, 2016

Evidence suggests that simply increasing knowledge and awareness of good nutrition practices rarely leads to sustained behavior change, nor is sustained change in nutrition behavior likely to be achieved through a single activity. Several specific behaviors or practices impact nutritional status during the critical first 1,000 days (pregnancy to age two), while complex, contextual determinants also influence individual decisions to consider, test, adopt and sustain a given behavior or practice. The field of Social and Behavior Change Communication (SBCC) is a collection of approaches and tools informed by behavioral theories and used to design public health interventions.

This review, part of a broader effort by SPRING to support governments and other stakeholders in their delivery of high impact nutrition practices, provides a summary of peer-reviewed evidence regarding the effectiveness of SBCC approaches to increase the uptake of three key nutrition behaviors: women’s dietary practices during pregnancy and lactation, breastfeeding practices, and complementary feeding practices. SBCC interventions have been broadly categorized into three areas: interpersonal communication; use of media; and community/social mobilization. This review also identifies gaps in the evidence and recommendations for further areas of study.

This review includes a total of 91 studies identified using the Ovid MEDLINE database. Recognizing the potential value of a broad array of study designs, results from five study types are included: reviews (including meta-analysis), randomized controlled trials, longitudinal studies, repeated cross-sectional studies, and cross-sectional studies. Excluded studies include those with data from high income countries, those published prior to 2000, those written in a language other than English, and those that focused exclusively on refinement of a research methodology. Other exclusions are noted in the text.

Click here for full review.

The Power of People-Centered Nutrition Interventions (Chapter 4.2 of Good Nutrition: Perspectives for the 21st Century, Karger e-book, 2016)

Dial ‘N’ for Nutrition? A Landscape Analysis of What We Know About m-Nutrition, m-Agriculture and m-Development (IDS Working Paper 481, 2017)

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