Suaahara Impact Evaluation: End-line Survey
Study Details
Study Description
Brief Summary
Suaahara's primary aim is to reduce the prevalence of stunting, wasting, and underweight among children under 5 years of age and to reduce the prevalence of anemia among women of reproductive age and children 6-59 months of age. For this, the program uses a multi-sectoral approach to achieve four key intermediate results: 1) improved household nutrition, sanitation, and health behaviors; 2) increased use of quality nutrition and health services by women and children; 3) improved access to diverse and nutrient-rich foods by women and children; and 4) accelerated roll-out of the Multi-Sectoral Nutrition Plan through strengthened local governance
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 3 |
Detailed Description
The Government of Nepal and development partners have prioritized multi-sectoral (integrated) nutrition as a key development agenda. The Suaahara program funded by the United States Agency for International Development is one of the programs that support the Government of Nepal's multi-sectoral nutrition plan. It aims to reduce maternal and child under-nutrition over a period of ten years, spanning two phases: Suaahara I (2011-2016) and Suaahara II (2016-2021). Initially launched in 20 of 75 districts, the program has scaled-up to 42 of 77 districts that span across Nepal's three agroecological zones of mountains, hills, and terai.
Suaahara I was led by Save the Children International in partnership with Helen Keller International, JHU Center for Communications Programs, JHPIEGO, Nepal Water for Health (NEWAH), the National Promotion and Consultancy Service, and the Nepali Technical Assistance Group (NTAG). Suaahara II was led by Helen Keller International in partnership with Cooperative for Assistance and Relief Everywhere, Inc., Family Health International 360), he Nepali Technical Assistance Group, Digital Broadcast Initiative Equal Access, Environmental and Public Health Organization, and Vijaya Development Resource Center.
Suaahara's primary aim is to reduce the prevalence of stunting, wasting, and underweight among children under 5 years of age and to reduce the prevalence of anemia among women of reproductive age and children 6-59 months of age. For this, the program uses a multi-sectoral approach to achieve four key intermediate results (IRs): 1) improved household nutrition, sanitation, and health behaviors; 2) increased use of quality nutrition and health services by women and children; 3) improved access to diverse and nutrient-rich foods by women and children; and 4) accelerated roll-out of the MSNP through strengthened local governance. Suaahara interventions span health and family planning (FP), nutrition, agriculture/homestead food production (HFP), and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors. Suaahara's conceptual framework illustrates the paths by which the program activities linked to desired outcomes achieve SII objectives.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intervention Suaahara interventions span health and family planning; nutrition; agriculture/homestead food production; and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors. |
Behavioral: Health and family planning
Promotion of health and family planning behaviors
Behavioral: Nutrition
Promotion of maternal, infant, and young child feeding behaviors and nutrition
Behavioral: Agriculture and homestead food production
Promotion of knowledge and practices about homestead food production
Behavioral: Water, sanitation, and hygiene
Promotion of behaviors to improve water, sanitation, and hygiene
|
| No Intervention: Comparison Usual care. |
Outcome Measures
Primary Outcome Measures
- Child dietary diversity (Indicators for Assessing Infant and Young Child Feeding Practices) [Over the 24 hours of the day before data collection]
Mean score, range 0 to 8, higher is better
- Maternal dietary diversity (Minimum Dietary Diversity for Women) [Over the 24 hours of the day before data collection]
Mean score, range 0 to 10, higher is better
- Stunting [Over the 24 hours of the day of data collection]
Prevalence of height or length for age zscore < -2
- Underweight prevalence [Over the 24 hours of the day of data collection]
Prevalence of weight for age zscore < -2
- Wasting [Over the 24 hours of the day of data collection]
Prevalence of weight for lengthor height zscore < -2
- Maternal underweight [Over the 24 hours of the day of data collection]
Prevalence of body mass index < 18.5
- Maternal anemia [Over the 24 hours of the day of data collection]
Prevalence < 12 g/dl
- Anemia among children aged 6-59 months [Over the 24 hours of the day of data collection]
Prevalence < 11 g/dl
- Accurate health, nutrition, and water, sanitation, and hygiene knowledge and skills among Female Community Health Volunteers and health workers from 52 items [Over the 24 hours of the day of data collection]
Prevalence > 80% correct from 52 items
Secondary Outcome Measures
- Child minimum dietary diversity (Indicators for Assessing Infant and Young Child Feeding Practices) [Over the 24 hours of the day before data collection]
Prevalence > 4 food groups of 8
- Maternal minimum dietary diversity (Minimum Dietary Diversity for Women) [Over the 24 hours of the day before data collection]
Prevalence > 4 food groups of 10
- Height for age [Over the 24 hours of the day of data collection]
Mean z-score
- Weight for age [Over the 24 hours of the day of data collection]
Mean z-score
- Weight for height [Over the 24 hours of the day of data collection]
Mean z-score
- Maternal body mass index [Over the 24 hours of the day of data collection]
Mean
- Maternal hemoglobin [Over the 24 hours of the day of data collection]
Mean in g/dl
- Child hemoglobin [Over the 24 hours of the day of data collection]
Mean in g/dl
- Knowledge score on core infant and young child feeding practices among mothers from 15 items [Over the 24 hours of the day of data collection]
Mean score, range 0 to 15, higher is better
- Knowledge score on health and water, sanitation, and hygiene practices among mothers from 37 items [Over the 24 hours of the day of data collection]
Mean score, range 0 to 37, higher is better
- Female Community Health Volunteers and health workers with ideal practices related to health, nutrition, and water, sanitation, and health from 52 items [Over the 24 hours of the day of data collection]
Prevalence > 80% correct from 52 items
Eligibility Criteria
Criteria
Inclusion Criteria:
-
At the household level, the primary respondents are mothers of children under 5 years of age from the selected households.
-
Other survey respondents include a primary male (or female, if male unavailable) household decision-maker, and a grandmother of children under 5 years of age residing in the household.
-
The Female Community Health Volunteer and health workers are also Suaahara beneficiaries, as the program explicitly aims to improve their knowledge and skills.
Exclusion Criteria:
- None.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Helen Keller International | Kathmandu | Nepal |
Sponsors and Collaborators
- University of South Carolina
- Helen Keller International
Investigators
- Principal Investigator: Edward A Frongillo, PhD, University of South Carolina
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 103