Assessing the impact of Ethiopia’s Community-based Nutrition programme on child nutrition

Conducted by: Tulane University

Department of Global Community Health and Behavioural SciencesSchool of Public Health and Tropical Medicine

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

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

CBN Routine Data

TR 2 Baseline TR 3 Baseline Midline

.

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

CBN evaluation: anthropometric changes

2008 2009 2010 2011 20120%

10%

20%

30%

40%

50%

60%

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 evalua-tion survey), in TRANCHE 2

Stunting Preva-lence

Expected Stunting Trend

Severe Stunting Prevalence

Expected Severe Stunting Trend

DHS 2011 Stunting Prevalence

CBN evaluation: contact with HEWs and VCHWs

CBN evaluation: change in IYCF indicators

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

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.