impact of deworming and micronutrient supplementation on maternal and child nutritional status

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Impact of Deworming and Micronutrient Supplementation on Maternal and Child

Nutritional status

End-line Preliminary Findings from a Randomised Control Trial in North-West Bangladesh with NDP

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Economic Empowerment/ Livelihood component:

1. Creating access to land•Land leasing •Promotion of share-cropping

2. Vegetables production and consumption

3. Cash support

Project activities

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Nutrition Component:

1. Behaviour Change Communication•Cooking demonstration•IYCF messages – Group meeting•Hygiene and Sanitation

2. Micronutrient supplements (MNS)

3. Regular deworming

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Total BHHs

Intervention Group

Control Group

Excluded (n = 15)

1043 BHHs

Baseline nutrition survey

Provision of supplements

Midline nutrition survey

Intervention Group

Control Group

End-line survey

Figure : Trial profileControl group will receive 3

months of supplementation

After 6 months of

supplementation

After 12 monthsDecember 2011

May-June 2011

December 2010

October 2010

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Methodology:

1.Longitudinal Panel study

2.Cluster Randomised Trial

3.Mixed Method (Qualitative & Quantitative)

4.Sample size (Quantitative): 1043 BHHs

537 Intervention

503 Control

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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 learnedBeneficiary perspectivesManagement issuesGuidance for scaling up and future project planning

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Data collected on: (Quantitative)

1.Socio-demography2.Anthropometry3.Blood Haemoglobin4.Morbidity5.Household Food Intake6.Food Coping Mechanism (Food Security)

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Preliminary Findings from the

End-line Survey

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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.

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Household Food Intake

1. Mean no of food items consumed

2. Another way of measuring food diversity based on 7 food groups as defined by WHO/UNICEF

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

diversity

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

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

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HOUSEHOLD FOOD SECURITYHouseholds asked about 10 food coping strategies

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Mean Food Coping Strategy fell from 4.56 to 2.2

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Maternal Nutritional Status

1.Anthropometry1. Change in body weight2. Change in Body Mass Index (BMI)3. Chronic energy deficiency (CED)

Measured by BMI

2.Haemoglobin (Anaemia)

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Mother’s Mean Haemoglobin concentration by HH head

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Upward trend in blood heamoglobin concentration was found in both male and female

headed households

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

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Change in Child (U-5) Nutritional Status

1.Anthropometry1. Weight for Height (wasting)2. Weight for Age (underweight)3. Height for Age (stunting)

2.Haemoglobin (Anaemia)

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Change in mean weight and height

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Weight for Height Z-Scores (WHZ)

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Height for Age Z-Scores (HAZ)

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Weight for Age Z-Scores (WAZ)

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Haemoglobin Concentration (Children-U5)

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Before the intervention

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After the intervention

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Limitation of the study1. No socio-economic information2. Lack of detailed dietary data

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THANKS

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Micronutrient Contents of each 1 gm sachetVitamin A 0.4mgVitamin C 30mgVitamin D 0.005mgVitamin E 5mgVitamin B1 0.5mg

Riboflavin  0.5mgNiacin 6mgPyridoxine 0.5mgVitamin B12 0.0009 mg

Folic acid 0.15mgIron 10mgZinc 4.10mgCopper 0.56mgSelenium 0.017mgIodine 0.09mg

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Methodology: (Mixed)1. Quantitative (Longitudinal trial)

Structured QuestionnaireAnthropometric and Hb Measurement

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2. Qualitative InvestigationFocus Group Discussions (BHHs)In-depth InterviewsInterviews of project staff

And.....3. NDP’s

MonitoringData

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Reasons for attrition

Attrition(number)

Attrition(%)

Intervention group

Control group

Intervention group

Control group

Migration 19 32 3.54 6.36

Not participating in programme activities

11 6 2.05 1.19

Morbidity and Mortality

1 15 0.19 2.98

Others 19 15 3.54 2.98

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

ATTRITION

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COMPLIANCE

mothers children U5

% of targeted beneficiaries receiving antehelmintics

94.1 98.1

% of targeted beneficiaries receiving MNP sprinkles

94.1 98.0

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Household Food Intake

Figure 2: Mean number of food types consumed by control and intervention group

Figure 3: Mean food diversity by control and intervention group

MFC- increased from 6.41 to 8.77 MFD- increased from 4.44 to 5.01

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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%

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Household Food Security

Figure 4: Mean food coping strategy by control and intervention groups

with a fall in mean number of coping strategies used from 4.56 to 3.77

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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

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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.

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MorbidityCondition Day of survey Previous 7 days Previous 30 days

Baseline Midline p Baseline Midline p Baseline Midline P

Diarrhoea

Control 10.5 6.0 0.023 29.2 24.1 ns 42.6 38.1 ns

Intervention

8.5 3.6 0.002 34.7 20.5 <0.001 44.6 31.9 <0.001

Total 9.4 4.8 <0.001 32.2 22.2 <0.001 43.7 34.9 <0.001

Passed worms

Control 20.6 14.6 0.022 48.8 25.2 <0.001 65.0 33.6 <0.001

Intervention

21.4 10.6 <0.001 49.9 19.9 <0.001 69.9 25.4 <0.001

Total 21.0 12.5 <0.001 49.0 22.5 <0.001 62.8 29.4 <0.001

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After veg After sprinkles

Intervention gp

Reduced illness Cold-Fever headaches weakness/dizziness diarrhoea/worms cold sores/lesions on lips

More of the previous + Greater increase in

appetite More energetic, normal health Kids with sprinkles no

illness compared to her older brother

Older women said she’s not dizzy and tired and working more

‘after taking sprinkles, sickness reduced so appetite increased’

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After veg After sprinkles

Control Less dizzy and weak, less fainting,

Intervention group look livelier and more energetic

Control No feverNo jaundiceNot loose motionBetter eyesightWalking stick gone!

Some of us have higher haemoglobin!

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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.

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Variables Control Group Intervention group CMS3 March 2011Survey Change Survey Change Survey P

Baseline

Midline Baseline

Midline Mar 10 Mar 11

Mean values No changes are significant

Weight 39.57 40.160.59

40.10 41.29 1.19 41.8 42.2 0.4

BMI 18.11 18.370.26

18.19 18.73 0.54 18.9 19.0 0.1

Haemoglobin 117.78 118.801.02

118.76 122.59 3.83 116.0 115.7 -0.3

CategoriesBMI <18.5 63.4 56.3

+7.158.0 51.6 +6.4 53.1 51.5 +1.6

Anaemic 51.7 51.70

53.3 33.6 +19.7 58.5 56.2 +2.3

Nutritional Status of Mothers

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Groups Nutritional status

Survey p Survey P

Control Mean Baseline Midline Prevalence (%)

Baseline Midline

Height-for-age -1.83 -1.73 ns Stunting 50.5 46.2 ns

Weight-for-age -2.13 -2.05 ns Underweight 51.6 51.6 ns

Weight-for-height

-1.57 -1.57 ns Wasted 34.1 29.7 ns

Haemoglobin 107.43 112.21 0.004 Anaemic 50.5 42.4 nsIntervention Height-for-age -1.53 -1.51 ns Stunting 38.9 41.6 ns

Weight-for-age -1.98 -1.88 ns Underweight 50.4 53.1 ns

Weight-for-height

-1.6 -1.5 ns Wasted 33.6 25.7 0.049

Haemoglobin 107.06 118.14 <0.001

Anaemic 53.2 20.2 <0.001

Child Nutritional Status

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Indicators(Change between baseline and midline)

Intervention(Midline – Baseline)

Control(Midline – Baseline)

(Intervention – Control)

CMS3 March 2011

Height-for-age +0.02 +0.11 -0.088 -0.16 Weight-for-age +0.099 +0.086 +0.013 -0.14 Weight-for-height

+0.085 -0.15 +0.24-0.07

Haemoglobin (g/l)+11.35 +5.14 +6.39

+4.0g/L

Indicators NDP Midline CMS3 March 2011

Height-for-age 0.5 % less stunting 2% more stunting

Weight-for-age 1 % more underweight 1.0% more underweight

Weight-for-height 6.4 % less wasting 1.0% less wasting

Haemoglobin (g/l) 22 % less anaemia 11% less anaemia

Intervention- 30% less anaemia

Control- 8.1% less anaemia

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Challenges faced and Lessons learned:

Integrating NutritionNutrient content

BCC components (Strengthen)IYCF messagesMessages for PW and BF motheres

Strong Intervention MonitoringWell desinged structure

Staff turnover

Contents:

Background and General Project ActivitiesStudy Design Changes in Nutritional Status Qualitative findings Limitations Challenges Faced Learnings

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