Impact Evaluation of a Community Nutrition and Livelihood Program on Child Nutrition in Rural Bangladesh

OBJECTIVES: Child undernutrition remains high in Bangladesh. Multi-sectoral approaches involving livelihood programs are needed to address the burden of undernutrition. This study examined the impact of an economic development (ED) program receiving poultry assets with/without gardening training added to the Positive Deviant (PD)/Hearth program in rural Bangladesh, compared to the PD/Hearth only (PDH), on child nutrition and health. METHODS: A total of 1,125 children aged 6–13 months with weight-for-age (WAZ) z-score<−1.0 who attended PD/Hearth sessions in September – November 2018 were enrolled in a cohort group in July – August 2019 for the program evaluation. Out of them, 532 were from ED households (PDH/ED). The cohort group was re-assessed in November 2020. A year of program impact between 2019 and 2020 on food security, dietary quality, and health behaviors, accounting for the socio-economic differences between two groups, was estimated using a difference-in-differences approach. RESULTS: The prevalence of underweight in the PDH and PDH/ED group decreased to 18.6% and 24.7% (p = 0.02) in 2019, but increased to 47.7% vs. 56.2% (p = 0.003) in 2020 without significant difference in program impact by adding the ED. Compared to the PDH group, the PDH/ED group increased a child dietary diversity score by 0.32 score and minimum dietary diversity (defined as four out of seven food groups) by 13.7 percentage points (pp), and a maternal dietary score by 0.28 score. The PDH/ED increased the proportion of food secured households by 12.6 pp, diversified crop production for banana (9.7 pp), papaya (11.7 pp), carrot (3.8 pp), and lemon (5.9 pp) (all p < 0.05), compared to the PD group. The proportion of households having income ≥ 84,000 Taka during the last year increased by 12.4 pp among PDH/ED group, compared to the PDH group (p = 0.003). There was no significant impact on child morbidity, maternal hand-washing practices. CONCLUSIONS: Adding an ED program to the PD/Hearth program improved food security and dietary diversity among children and mothers in rural Bangladesh. FUNDING SOURCES: World Vision Bangladesh.