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Social and Behavioral Change Interventions Delivered at Scale Have Large Impacts on Infant and Young Child Feeding (IYCF) Practices in Bangladesh
Author(s) -
Me P,
Saha K,
Kennedy A,
Khaled A,
Tyagi T,
Sanghvi T,
Afsana K,
Haque R,
Frongillo E,
Ruel M,
Rawat R
Publication year - 2015
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.29.1_supplement.584.30
Subject(s) - breastfeeding , medicine , psychological intervention , meal , zoology , demography , behavior change communication , environmental health , pediatrics , population , biology , health services , sociology , psychiatry
Alive & Thrive (A&T) in Bangladesh aims to improve IYCF through 1) a national mass media (MM) campaign, 2) social mobilization and 3) interpersonal communication delivered by health workers from BRAC, and implemented at scale in 50 sub‐districts. A cluster‐randomized evaluation was conducted in 20 sub‐districts, 10 receiving all 3 interventions (A&T‐3) and 10 with MM only (A&T‐MM). Impact indicators were IYCF practices in children <24 mo and attained linear growth in children 24‐47 mo. Cross‐sectional surveys [N~2200/ group] at baseline (2010) & endline (2014) were used to derive cluster‐adjusted double‐difference estimates (DDE). Large, significant impacts were seen on 7 WHO IYCF indicators: early breastfeeding (BF) initiation (63.5 → 94.5 in A&T‐3, p<0.001 for DDE), exclusive BF (48.5 → 86.0 in A&T‐3, p<0.001), timely introduction of complementary feeding (45.9 → 97.5 in A&T‐3, p<0.05), minimum dietary diversity (32.1 → 61.7 in A&T‐3, p<0.01), minimum meal frequency (42.1 → 72.3 in A&T‐3, p<0.001), minimum acceptable diet (16.0 → 49.3 in A&T‐3, p<0.001), and intake of iron‐rich foods (39.5→ 78.6 in A&T‐3, p<0.001). Continued BF, already high in 2010, remained as high in both groups in 2014 (DDE n.s.). Stunting decreased in both A&T‐3 and A&T‐MM over this period (DDE n.s.). The large scale A&T‐3 model led to substantial comparative increases in IYCF practices, providing evidence for investments in such models to improve IYCF at scale. Funding: Bill & Melinda Gates Foundation, via Alive & Thrive, managed by FHI360.