Abstracts

Abstract

Malnutrition in women and children in Bangladesh is one of the highest in the world with 33% of <5 children underweight and 36% stunted (NIPORT 2014). Imbalanced diet and inappropriate feeding practices are the major determinants of child undernutrition. Poverty, low income, and price hikes restrict poor families from accessing sufficient and diversified nutritious foods, which leads to their food and nutrition insecurity (Ghose 2014). To generate positive impacts on nutritional outcomes, agricultural interventions require more focus on nutrition and need to be linked to nutrition specific interventions (Haselow et al 2016). Improving homestead fruit and vegetable production integrating with enhanced communications about nutrition would lead to improved dietary diversity and nutritional status of children (Mulmi 2017). Combining agriculture with behaviour change communication and nutrition-sensitive interventions would improve diet and feeding quality to reduce child undernutrition. Such integrated intervention requires rigorous design and implementation strategy to generate an impact.This study aims to assess the feasibility and acceptability of an intervention package that combines nutrition-specific (nutrition counselling) and nutrition-sensitive (counselling and support for agriculture, and unconditional cash transfers) delivered on a mobile phone platform for improving maternal and child feeding behaviours among low-income families in rural Bangladesh. We conducted a mixed-methods feasibility study. The intervention included counselling on homestead gardening techniques and infant feeding by agriculture and nutrition workers using smartphone apps. Women received weekly individual counselling at home and group counselling fortnightly. Each participating woman received an unconditional monthly incentive of BDT 1200 cash transfer through a mobile banking system called bKash. The intervention took place for 6 months. We collected data through in-depth interviews and a cross sectional surveys of the participants and their family members.The women were interested in both agriculture and nutrition counselling and understood the messages clearly.They established homestead garden of seasonal vegetables successfully that included preparing beds, planting seedlings, nurturing the plans, and harvesting. Seasonal rainfall and damage by hens and ducks were major challenges but most of the families were able to find a solution. Most of the women preferred to consume own produced vegetables and spending the cash provided on purchasing nutritious foods such as fruits, egg, and milk for their children as advised in the counselling. The project implementation staff and the bKash agent did not report any difficulties in using the mobile banking system for cash transfer. Combining nutrition-specific and nutrition-sensitive interventions is a feasible and acceptable approach to the community to improve maternal and infant feeding practices. Using mobile phone technologies can provide additional benefit for the intervention to rea...