SESSION 2: Field Program Examples
OBJECTIVES
• Discover what types of integrated programs are feasible,
especially at scale
• Identify challenges and opportunities in integration
OUTPUT
• A list of challenges and a list of opportunities
Communication
Campaign for
Reducing Stunting
through IYCF +
Handwashing
Represented by Tina Sanghvi, Alive &
Thrive, FHI 360
Bangladesh| Alive & Thrive, FHI 360
Program aims
• Prevent stunting
– Complementary feeding practices,
especially nutrient-dense foods and
animal source foods (existing program)
– Handwashing to decrease infection, allow
for better use of nutrients
• Create intervention that WASH sector
will pick up, including nutrition
Areas of integration
• WASH:
– Wash hands with soap:
• Before mashing child’s food
• Before feeding child
– Wash child’s hands
• IYCF:
– Feed right quantity, frequency
– Feed 4 varieties of foods/day, focus on animal
source foods
• ECD:
– [Responsive feeding]
Constraints & Motivators
• Make it convenient: HW station (water
and soap) near feeding area
• Shift social norms: Engage community
members, make the practices seem
normal, expected
• Make health benefits credible: Stress
protection from illness, germs
The intervention
Social mobilization
guidelines
Results from Trial Phase
• Increased HW with soap before preparing
food and feeding
– Presence of handwashing station at feeding
place increases HW at key times
• Increased feeding of right quantity and
frequency family food
• Little impact on feeding 4 varieties of
foods
• Little interest from WASH colleagues
MAMA, South
Africa
Mobile Alliance for
Maternal Action
Represented by Kirsten Gagnaire,
Global MAMA
South Africa| MAMA
Program aims
• Deliver vital health information to new and
expectant mothers through mobile phones
• Inform and empower low-income, expectant
mothers who are at risk of complications and
death during pregnancy and childbirth, and
new mothers caring for their infants
• Encourage care seeking behavior and regular
clinic visits for immunizations and check ups
Areas of integration
• WASH:
– Handwashing, food safety, safe water
• IYCF:
– Exclusive breastfeeding, appropriate
complementary feeding
• ECD:
– Early stimulation, appreciation of
developmental stages
The intervention
Results
• Targeting health information to user’s gestational
age or the age of child markedly increases
acceptability of the service and user retention
• Mothers appreciate the opportunity to connect
with other mothers and feel empowered by the
feeling of belonging to a community
• Project implementation best done through
consortium of partners: with technical and
content expertise, access to clinical services, and
experience in monitoring and evaluation
Video: MAMA South Africa Mashup
https://www.youtube.com/watch?v=2Rm
Iwr0dpmE
Educational
intervention
delivered through
health services to
improve child
nutrition
Represented by Rebecca Robert,
Catholic University of America, visiting
investigator with Instituto de
Investigación Nutricional
Peru | Instituto de Investigación Nutricional
Johns Hopkins University
Ministry of Health, Dept. La Libertad
Program aims
• Prevent stunting through
improved feeding practices
• Design and test educational
intervention (not providing
food) (cluster RCT)
• Raise profile of nutrition in
health centers, strengthen
existing government health
services without increasing
personnel or costs
Areas of integration
• WASH:
– [Wash hands, food, plate when preparing food]
• IYCF:
– Give thick puree
– Give animal source foods (liver, egg, fish)
• ECD:
– Interactive (responsive) feeding:
•
•
•
•
[Teach baby to eat]
[Help baby to eat by himself]
[Eat as a family]
[If child won’t take food, wait, offer again]
3 Key Messages
1. At each meal give thick
puree first
2. Add special food: liver,
egg or fish
3. Teach your child to eat with
love, patience, and good
humor
The intervention
% Children
Percentage of children with stunting
by age and intervention group
18
16
14
12
10
8
6
4
2
0
0
3
6
9
12
Age in months
15
18
Intervention
Control
Results
“Before, only the nutritionist gave
messages. Now, we all give messages
because we all speak the same
language (of key messages), we all say
the basic messages.”
Early Stimulation
and Nutrition
Program
in Rural
Bangladesh
Represented by Ivelina Borisova, Save
the Children
Bangladesh | Save the Children
Program aims
• Growth and development
– Height for age
– MUAC (mid- to upper-arm circumference)
– Cognitive and language development
• Sustainable and scalable model for
improving stimulation and nutrition
caregiving practices
Areas of integration
• WASH:
– Wash hands with soap before feeding
– Wash child’s hands before s/he eats
• IYCF:
– Feed a variety of nutritious foods, especially animal
source foods
– Feed with patience and good humor; encourage self
feeding
• ECD:
– Give child affection, show love, every day
– Play games every day and let the child play with
playthings
– Talk to and with your child; respond to child’s
sounds
The Intervention
Save the Children & Department
of Health and Family Planning
Family Welfare Assistants
Parent education support through
home visits, community and
satellite clinics
Mothers of children 0-3 years
25
Child Development Card
Child Development Card
Results from first phase
• Impact on growth and development
– No impact on height for age (short
intervention period,10 months)
– Large impact on language and cognitive
development (d=1.52 and 1.04 respectively)
• Household practices
– Improved caregiver-child interactions at home
– Increased breastfeeding rates
– Little impact on feeding animal source foods
• Some impact on diarrhea rates
Changing multiple
behaviours
Presented by Val Curtis, London School
of Hygiene and Tropical Medicine
Zambia| Nepal| Indonesia| India
social
biological
biological
executive
setting
setting
reactive
brain
behaviour
motivated
body
Evo-Eco model
physical
environment physical
environment
Settings
• Kitchen makeover
parties
Manners
Brand
Nurture
Video: SuperAma animation
• http://www.youtube.com/watch?v=J3Fi
IQQuiQw
SESSION 3: Shared Indicators
OBJECTIVE
• To identify impact indicators of growth and development
that could be used in a coordinated program
OUTPUT
•
List of impact indicators
SESSION 4: Household Practices
OBJECTIVES
• To review the household practices (or behaviors) critical to child
growth and development, as currently articulated by each
sector - ECD, Nutrition and WASH
• To develop a (preliminary) comprehensive list of priority
household practices for use across sectors
• To identify feasible opportunities for program integration,
promoting key household practices from each sector
OUTPUT
• A matrix of key behaviors by age cohort
• Ideas for integrating key behaviors into sector programming
• List of challenges to integration, with possible solutions
SESSION 5: Future Actions
OBJECTIVES
• To identify specific opportunities for moving forward with
collaboration to advance child growth and development
• To allow participants to make a public commitment of
resources to specific collaborative actions
• To identify ways to share the spirit and outputs of this
meeting with the broader community – the three sectors
and the child health and education communities
OUTPUT
• List of potential collaborative actions, with names of
people and/or organizations attached