A program impact pathway‐based process evaluation helps trace program implementation processes essential to achieving changes in infant and young child feeding practices in the Alive & Thrive initiative in Bangladesh (251.4)

A&T aims to improve IYCF practices through intensive interpersonal communication (IPC) by well‐trained frontline workers (FLWs) and a mass‐media (MM) campaign. A cluster‐randomized impact evaluation in 20 subdistricts comparing A&T intensive [(A&T‐I) (IPC+MM)] and A&T non‐intensive [(A&T‐NI) (MM only)] areas shows positive early impacts of A&T‐I interventions ( Menon et al.2013 ). A PIP‐based PE was conducted to examine 5 domains: FLW training; service delivery; coverage; service utilization; and behavioral impacts. Data: Surveys of randomly selected households with children 0‐23 mo (N=1000 per group) in 2010 (baseline) and 2013; 90 in‐depth qualitative interviews. At baseline, there were no differences in any domains. In A&T‐I areas in 2013, IYCF knowledge of FLW was better; FLW home visits were higher (89% vs. 40% in last 1 mo; p<0.05); and more mothers received IYCF advice from FLW (92% vs. 50%; p<0.05) compared to A&T‐NI areas. Maternal recall of 6 MM television spots in A&T‐I areas was 45‐65% and was slightly higher than in A&T‐NI areas (n.s.). Maternal IYCF knowledge, particularly of breastfeeding and introduction of complementary foods was better (p<0.05) in A&T‐I areas. Qualitative data shows that some negative social norms still persist and that infants were rarely fed adequate diets throughout the first 2 y of life. This PIP‐based PE indicates that key program elements of coverage, quality of service and intervention reach are in place, but some household‐level factors could limit impact. Grant Funding Source : Funding: Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360.