Suchergebnisse

OBJECTIVES: Frontline health workers (FLW) are needed for delivering interventions at scale to reduce maternal and child undernutrition, but low- and middle-income countries often face inadequate FLW performance. This study aimed to test whether and how intervention design elements such as training, supervision, and mass media improved FLW performance in delivering nutrition services. METHODS: Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh and Vietnam. FLWs in A&T intensive (A&T-I) areas received specialized IYCF training, job aids, and regular supportive supervision. Those in A&T non-intensive (A&T-NI) areas received standard government training and supervision; there was mass media exposure in both areas. Multiple regression was used to test differences in exposure to intervention design elements and performance outcomes between the two intervention areas. Structural equation modeling was conducted to examine the paths from exposure to performance outcomes measured at the FLW and end-user levels. RESULTS: Compared to FLWs in A&T-NI areas, those in A&T-I areas had higher scores in training (by 1.3–3.6 out of 10 points), supportive supervision (by 0.3–3.5 points), and mass media exposure (by 0.3–3.5 points). These intervention design elements were significantly associated with FLW knowledge and motivation, which in turn improved service delivery. FLW-level performance outcomes contributed to improving end-user-level outcomes such as higher service utilization (β = 0.12–1.04 in Bangladesh and 0.11–0.96 in Vietnam) and maternal knowledge (β = 0.12- 0.17 in Bangladesh and 0.04–0.21 in Vietnam). CONCLUSIONS: Training, supervision, and mass media exposure can contribute to improved FLW service delivery by enhancing knowledge and motivation, which in turn positively influence mother's service utilization and IYCF knowledge. These elements and ...

Childhood stunting has declined in India between 2006 and 2016, but not uniformly across all states. Little is known about what helped some states accelerate progress while others did not. Insights on subnational drivers of progress are useful not just for India but for other decentralised policy contexts. Thus, we aimed to identify the factors that contributed to declines in childhood stunting (from 52.9% to 37.6%) between 2006 and 2016 in the state of Chhattisgarh, a subnational success story in stunting reduction in India. ; PR ; IFPRI3; 2 Promoting Healthy Diets and Nutrition for all; CRP4; POSHAN; Stories of Change in Nutrition ; PHND; A4NH ; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Data systems and their usage are of great significance in the process of tracking malnutrition and improving programs. The key elements of a data system for nutrition include (1) data sources such as survey and administrative data and implementation research, (2) systems and processes for data use, and (3) data stewardship across a data value chain. The nutrition data value chain includes the prioritization of indicators, data collection, curation, analysis, and translation to policy and program recommendations and evidence based decisions. Finding the right fit for nutrition information systems is important and must include neither too little nor too much data; finding the data system that is the right fit for multiple decision makers is a big challenge. Developed together with NITI Aayog, this document covers issues that need to be considered in the strengthening of efforts to improve the availability and use of data generated through the work of POSHAN Abhiyaan, India's National Nutrition Mission. The paper provides guidance for national-, state-, and district-level government officials and stakeholders regarding the use of data to track progress on nutrition interventions, immediate and underlying determinants, and outcomes. It examines the availability of data across a range of interventions in the POSHAN Abhiyaan framework, including population-based surveys and administrative data systems; it then makes recommendations for the improvement of data availability and use. To improve monitoring and data use, this document focuses on three questions: what types of indicators should be used; what types of data sources can be used; and with what frequency should progress on different indicator domains be assessed. ; Non-PR ; IFPRI1; DCA; POSHAN; 2 Promoting Healthy Diets and Nutrition for all ; PHND; SAR

This report presents the findings of an operations research study conducted to assess the implementation of the Government of Bangladesh's National Nutrition Services Program (NNS) and to identify the achievements, determine the bottlenecks that adversely impact these achievements, and highlight potential solutions to ensure smooth delivery of the program. A mixed methods research approach was used to evaluate five major domains of the program: management and support services; training and capacity development; service delivery; monitoring and evaluation, and; exposure to interventions. The study found that the overall NNS effort is an ambitious, but valuable approach to support nutrition actions through an existing health system with diverse platforms. The results indicate that although the maintenance of strong and stable leadership of NNS is an essential element to ensure integrated and well-coordinated comprehensive service delivery for the line directorate, the current arrangement is unable to ensure effective implementation and coordination of NNS. Focusing on some of the critical challenges related to leadership and coordination in the first instance, and on embedding a small core set of interventions into well-matched (for scale, target populations, and potential for impact) health system delivery platforms is most likely to help achieve scale and impact. Strategic investments in ensuring transparency, engaging available technical partners for monitoring and implementation support, and not shying away from other potential high coverage outreach platforms like some NGO platforms also could prove fruitful. Moreover, although the Government of Bangladesh, and the health system in particular, must lead the effort to deliver for nutrition, it is clear that development partners who have expressed a commitment to nutrition must coordinate their own activities and provide the support that can deliver on nutrition's potential for Bangladesh.

Objectives: The COVID-19 pandemic is expected to have extensive effects on healthcare systems. The Government of Bangladesh has concerns about diminished coverage and quality of maternal and child health services, but little published information exists on service provision, utilization, and adaptations. We examined changes to maternal and child health and nutrition service delivery and utilization in urban Bangladesh during and after the enforcement of COVID-19 restrictions and identified adaptations and potential solutions to strengthen service delivery and uptake. Methods: We conducted longitudinal surveys with health care providers (n = 45), pregnant women (n = 40), and mothers of children < 2 years (n = 387) in February 2020 (in-person) and September 2020 (by phone). We used Wilcoxon matched-pairs signed-rank tests to compare the changes before and during the pandemic. Results: Most services for pregnant women remained available during COVID-19 restrictions, with the provision of antenatal care (ANC) services falling by 6.6 percentage points (pp). Services for women and children which require proximity, however, were more severely affected; weight and height measurements fell by 20–29pp for pregnant women and 37–57pp for children, and child immunizations fell by 38pp. Declines in service utilization were large, including drops in facility visitations (35pp among pregnant women and 67pp among mothers), health and nutrition counseling (up to 73pp), child weight measurements (50pp), and immunizations (61pp). The primary method of adaptation was provision of services over phone (37% for ANC services and 44–49% for counselling of pregnant women or mothers with young children). Conclusions: Despite adaptations to service provisions, continued availability of routine maternal and child health services did not translate into service utilization. Further investments are needed to provide timely and accurate information on COVID-19 to the public, improve COVID-19 training and provide incentives for health care providers, and ensure availability of personal protective equipment for both providers and beneficiaries. ; Non-PR ; IFPRI5; CRP4; POSHAN; Alive and Thrive; 2 Promoting Healthy Diets and Nutrition for all ; PHND; A4NH; SAR ; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Undernutrition among women and children contributes to almost half the global burden of child mortality in developing countries. The impact of nutrition on economic development has highlighted the need for evidence-based solutions and yielded substantial global momentum. However, it is now recognized that the impact of evidence-based interventions is limited by the lack of evidence on the best operational strategies for scaling up nutrition interventions. With the goal of encouraging greater engagement in implementation research in nutrition and generating evidence on implementation and utilization of nutrition interventions, this paper brings together a framework and a broad analysis of literature to frame and highlight the crucial importance of research on the delivery and utilization of nutrition interventions. The paper draws on the deliberations of a high-level working group, an e-consultation, a conference, and the published literature. It proposes a framework and areas of research that have been quite neglected, and yet are critical to better understanding through careful research to enable better translation of global and national political momentum for nutrition into public health impact. ; http://dx.doi.org/10.1111/nyas.12447 ; http://onlinelibrary.wiley.com/doi/10.1111/nyas.12447/abstract

Undernutrition among women and children contributes to almost half the global burden of child mortality in developing countries. The impact of nutrition on economic development has highlighted the need for evidence-based solutions and yielded substantial global momentum. However, it is now recognized that the impact of evidence-based interventions is limited by the lack of evidence on the best operational strategies for scaling up nutrition interventions. With the goal of encouraging greater engagement in implementation research in nutrition and generating evidence on implementation and utilization of nutrition interventions, this paper brings together a framework and a broad analysis of literature to frame and highlight the crucial importance of research on the delivery and utilization of nutrition interventions. The paper draws on the deliberations of a high-level working group, an e-consultation, a conference, and the published literature. It proposes a framework and areas of research that have been quite neglected, and yet are critical to better understanding through careful research to enable better translation of global and national political momentum for nutrition into public health impact.

IFPRI3; ISI; CRP4 ; PHND; SAO; A4NH ; PR ; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

The Indian state of Odisha has made significant strides to address health and nutrition in the last 25 years. We used public data, policy and program documents, published literature, and interviews with program and policy decision-makers, development partners, civil society members (n=29) and community members (n=45) to analyze these changes. Factors that contributed to scale up of health and nutrition interventions and the food security program included overarching policy support, financing at the national and state level, leadership across sectors from government to civil society and development partners, capacity and stability of tenure of bureaucrats, and state innovations in service delivery interventions. Barriers that may impede further progress include lack of sanitation, low levels of women's education, early marriage in girls, livelihood distress, and uneven progress across social groups.