392 - The Effectiveness of Specialized Nutritious Foods and Behavior Change Communication Interventions during the first 1000 days of life to prevent stunting in Afghanistan.

Publication Number: 392.6545

Sajid B. Soofi, Aga Khan University, Karachi, Sindh, Pakistan; Muhammad Umer, Aga Khan University, Karachi, Sindh, Pakistan; Imtiaz Hussain, Aga Khan University, Karachi, Sindh, Pakistan; Gul Nawaz Khan, Aga Khan University, Karachi, Sindh, Pakistan; Shabina Ariff, AKU, karachi, Sindh, Pakistan

Background: Considerable evidence supports the effectiveness of nutritional supplementation with or without nutrition education in preventing stunting
in developing countries, but evidence from Afghanistan is scarce.

Objective: This project aimed to assess the effectiveness of specialized nutritious food (SNF), social and behavior change communication (SBCC)
intervention to prevent stunting among children under two years during the first 1000 days of life in Afghanistan.

Design/Methods: We used a community-based quasi-experimental pre–post-study design with a control group. Pregnant and lactating women received a monthly
ration of 7.5 kg of super cereal (250 g/d) during pregnancy and the first 6 months of breastfeeding. Children aged 6–23 months received 30 monthly sachets of medium quantity lipid-based nutrient supplement (50 g/sachet/d). We compared pre- and postintervention assessments of the intervention and control groups to isolate the effect of the intervention on key study outcomes at the endline by difference-in-differences (DID) estimates.

Results: A total of 2928 and 3205 households were surveyed at baseline and endline. DID estimates adjusted for child, maternal, and household characteristics indicated a significant reduction in stunting (DID: _5% (95% confidence interval [CI]: _9.9, _0.2) and underweight (DID: _4.6% (95% CI: _8.6, _0.5) among children < 2 y of age. However, DID estimates for wasting among children in the intervention and control groups were not significantly different (DID: _1.7 (95% CI: _5.1, 1.6). Furthermore, exposure to the SBCC messages was associated with improvements in the early initiation of breastfeeding (DID: 19.6% (95% CI: 15.6, 23.6), exclusive breastfeeding under 6 mo (DID: 11.0% (95% CI: 2.3, 19.7), minimum meal frequency (DID: 23% (95% CI: 17.7, 28.2), and minimum acceptable diet (DID: 13% (95% CI: 9.8, 16.3).

Conclusion(s): The provision of SNF in combination with SBCC during the first 1000 days of life was associated with a reduction in stunting and underweight and improvements in infant and young child feeding practices among children under two years of age.

Socio-demographic characteristics of study population and participants
Table 1.pdfValues are presented as mean ± SD or n (%).
Improved water (piped into dwelling, piped to yard/plot/neighbor, public tap/standpipe, tube well or borehole or suction pump, hand pump, protected well, rainwater, filtration plant and bottled water).
Unimproved water (unprotected well, protected spring, unprotected spring, tanker truck, cart with small tank, surface water (river/dam/lake/pond/canal/irrigation channel), other facility).
Improved sanitation facility (flush to piped sewer system, flush to septic tank, flush to pit latrine, ventilated improved PIT latrine and PIT latrine with slab.
Unimproved sanitation facility (flush to somewhere else, PIT latrine without slab/open pit, bucket toilet, no facility/bush/field, other facility).

Impact on child nutritional status among children under 2 years in control and intervention groups by DID estimates
Table 2.pdfa. Unadjusted and adjusted differences in difference were obtained from mixed linear regression models with an interaction term between health area (intervention vs control) and time (endline vs baseline).
b. Multivariable models adjusted for child sex, age, maternal age, education, skilled birth attendant, facility births, IYCF practices, maternal BMI, and household characteristics.
DiD, difference-in-differences.

Impact of SBCC interventions on IYCF practices in control and intervention groups by DID estimates*
Table 3.pdf*Figures in parentheses are percentages of respondents
DiD, difference-in-differences. IYCF, infant and young child feeding. SBCC, social and behavior change communication.

Socio-demographic characteristics of study population and participants
Table 1.pdfValues are presented as mean ± SD or n (%).
Improved water (piped into dwelling, piped to yard/plot/neighbor, public tap/standpipe, tube well or borehole or suction pump, hand pump, protected well, rainwater, filtration plant and bottled water).
Unimproved water (unprotected well, protected spring, unprotected spring, tanker truck, cart with small tank, surface water (river/dam/lake/pond/canal/irrigation channel), other facility).
Improved sanitation facility (flush to piped sewer system, flush to septic tank, flush to pit latrine, ventilated improved PIT latrine and PIT latrine with slab.
Unimproved sanitation facility (flush to somewhere else, PIT latrine without slab/open pit, bucket toilet, no facility/bush/field, other facility).

Impact on child nutritional status among children under 2 years in control and intervention groups by DID estimates
Table 2.pdfa. Unadjusted and adjusted differences in difference were obtained from mixed linear regression models with an interaction term between health area (intervention vs control) and time (endline vs baseline).
b. Multivariable models adjusted for child sex, age, maternal age, education, skilled birth attendant, facility births, IYCF practices, maternal BMI, and household characteristics.
DiD, difference-in-differences.

Impact of SBCC interventions on IYCF practices in control and intervention groups by DID estimates*
Table 3.pdf*Figures in parentheses are percentages of respondents
DiD, difference-in-differences. IYCF, infant and young child feeding. SBCC, social and behavior change communication.