Social Franchising and a Nationwide Mass Media Campaign Increased the Prevalence of Adequate Complementary Feeding in Vietnam: A Cluster-Randomized Program Evaluation

Abstract

Background: Rigorous evaluations of health system–based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM).Objective: We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators.Methods: A cluster-randomized, nonblinded evaluation design with cross-sectional surveys (n = ∼500 children aged 6–23.9 mo and ∼1000 children aged 24–59.9 mo/group) implemented at baseline (2010) and endline (2014) was used. Difference-in-difference estimates (DDEs) of impact were calculated for intent-to-treat (ITT) analyses and modified per-protocol analyses (MPAs; mothers who attended the social franchising at least once: 62%).Results: Groups were similar at baseline. In ITT analyses, there were no significant differences between groups in changes in CF practices over time. In the MPAs, greater improvements in the intensive than in the nonintensive group were seen for minimum dietary diversity [DDE: 6.4 percentage points (pps); P < 0.05] and minimum acceptable diet (8.0 pps; P < 0.05). Significant stunting declines occurred in both intensive (7.1 pps) and nonintensive (5.4 pps) groups among children aged 24–59.9 mo, with no differential decline.Conclusions: When combined with MM and CM, an at-scale social franchising approach to improve IPC, delivered through the existing health care system, significantly improved CF practices, but not child growth, among mothers who used counseling services at least once. A greater impact may be achieved with strategies designed to increase service utilization. This trial was registered at clinicaltrials.gov as NCT01676623.

Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh

“…In Bangladesh, combined intensive interventions resulted in significant improvements in exclusive breastfeeding (EBF) (by 36.2 percentage points—pp), early initiation of breastfeeding (EIBF) (by 16.7 pp) ( 16 ), and CF practices (16.3 pp, 14.7 pp, 22 pp, and 24.6 pp for minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich foods, respectively) ( 16 , 17 ). Similar results were obtained in Vietnam ( 18 ); and patterns of increased EBF, EIBF, and multiple CF practices in intervention areas were observed in Ethiopia ( 15 ). Evaluations of other large-scale BCC interventions similarly showed a significant increase in EBF through BF counseling within a routine health service delivered by community health agents in Brazil ( 19 ) and improvements in both BF and CF practices through peer counseling by mother support groups in India ( 20 ).…”

“…Recent impact evaluations of large-scale behavior-change communication (BCC) interventions to improve IYCF practices in several countries have shown that intensive interpersonal counseling (IPC) combined with mass media (MM) and community mobilization (CM) activities have positive impacts on breastfeeding (BF) ( 15 , 16 ) and complementary feeding (CF) practices ( 15 , 17 , 18 ). In Bangladesh, combined intensive interventions resulted in significant improvements in exclusive breastfeeding (EBF) (by 36.2 percentage points—pp), early initiation of breastfeeding (EIBF) (by 16.7 pp) ( 16 ), and CF practices (16.3 pp, 14.7 pp, 22 pp, and 24.6 pp for minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich foods, respectively) ( 16 , 17 ).…”

Determinants of Stunting Children (0-59 Months) in Some Countries in Southeast Asia

“…In Thailand, Concentra on among the poor was greatest and was sta s cal significant for child underweight and stun ng (Limwa ananon S, Tangcharoensathien V, Prakongsai P, 2010). The general improvements in socioeconomic status observed during the study period in Vietnam led to significant improvements in anthropometric indicators over me (Rawat R, Nguyen PH, Tran LM, Hajeebhoy N, Nguyen H Van, Baker J, et al, 2017). In Cambodia, stun ng had weak correla on with household's wealth index (r = 0.06, P = 0.088) (Reinbo A, Kuchenbecker J, Herrmann J, Jordan I, Muehlhoff E, Kevanna O, et al,2015) and in other study, child stun ng showed a sta s cally significant associa on with household wealth index scores (Ikeda N, Irie Y, Shibuya K, 2013).…”

“…Introduc on of CFs earlier than 4 months of age was a risk factor for being underweight (age-adjusted odds ra o (OR adjust-age) = 1.7, 95% confidence interval (CI) = 1.2-2.5) and for stun ng (OR adjust-age = 1.6, 95% CI = 1.1-2.3) (Zhao A, Gao H, Li B, Zhang J, Win NN, Wang P, et al ,2016). But in Vietnam, although Social Franchising significantly improving Complementary Feeding Prac ce but it was not improved child growth (Rawat R, Nguyen PH, Tran LM, Hajeebhoy N, Nguyen H Van, Baker J, et al, 2017). In Cambodia, None of the WHO IYCF indicators was associated with LAZ, whereas CFI showed significant associa on with LAZ (P = 0.01).…”

“…When combined with mass media and community mobiliza on, an at-scale social franchising approach to improve interpersonal counseling, delivered through the exis ng health care system, significantly improved complementary feeding prac ces, but not child growth, among mothers who used counseling services at least once. A greater impact may be achieved with strategies designed to increase service u liza on (Rawat R, Nguyen PH, Tran LM, Hajeebhoy N, Nguyen H Van, Baker J, et al, 2017). Even where local resources allow for adequate infant and young child feeding, nutri onal knowledge and awareness, and factors such as mothers' available me are crucial to improving the nutri onal status of the children.…”