Unintended consequences of programmatic changes to infant and young child feeding practices in Bangladesh

Abstract

BRAC, an international development organization, implemented a home-fortification programme from 2014 to 2018 in Bangladesh. This study aimed to understand the unintended consequences of programmatic changes that occurred during the implementation of the programme on the prevalence of good infant and young child feeding (IYCF) practices and other associated factors. We used pooled data from eight cross-sectional surveys and data from a series of qualitative investigations carried out as part of a mixed-methods evaluation approach. A total of 6,479 caregivers of children aged 6 to 23 months participated in the surveys. The prevalence of good IYCF practices increased from baseline (42.1%) to midline (45.3%), but it decreased at the endline survey (31.9%). Qualitative investigations identified several reasons for low IYCF practices at the programme level, such as the withdrawal of community health worker (CHW) incentives for promoting IYCF, providing incentives for the home-fortification of micronutrient powder (MNP) and changing the focus from IYCF promotion to MNP promotion. A multivariable generalized estimating equation model for pooled data revealed that caregivers were 28% (adjusted risk ratio [ARR]: 0.72, 95% CI [0.67, 0.78]) less likely to maintain good IYCF practices during the period when CHWs were not incentivized to promote IYCF compared to the period when CHWs were incentivized to promote it. The prevalence of good IYCF practices decreased from both baseline and midline to the endline survey due to the unintended consequences of the programmatic changes. An integrated intervention strategy to promote the home-fortification of MNP and IYCF could be helpful to avoid unintended negative consequences of programmatic changes.

The Effects of Deworming and Multiple Micronutrients on Anaemia in Preschool Children in Bangladesh: Analysis of Five Cross-Sectional Surveys

“…The participating children received deworming medication only when they visited physicians or local doctors when unwell. Detailed descriptions of the survey designs and BRAC programme platforms are published elsewhere [ 24 , 25 , 26 ]. Data for the present study were collected from 27 districts across eight administrative divisions (Barisal, Dhaka, Chittagong, Khulna, Mymensingh, Rajshahi, Rangpur, and Sylhet divisions) and from two urban slums in the Dhaka North City-Corporation in Bangladesh.…”

“…In the second stage, we used a mapped segmented sampling strategy to identify the study households. A detailed description of the sampling strategy is published elsewhere [ 26 ].…”

Effect of home visits by community health workers on complementary feeding practices among caregivers of children aged 6–23 months in 10 districts of Bangladesh

“…The icddr,b-a Bangladesh-based international health research institute was commissioned to evaluate this MIYCN programme, and it conducted cross-sectional surveys as part of periodic assessment of the programme. A detailed description of the evaluation and BRAC programme is published elsewhere (7,12,13). For this article, we used data from two cross-sectional surveys (a baseline and a follow-up survey) conducted in 10 districts of the programme areas to understand the effect of home visits by CHWs on complementary feeding practices among caregivers of the children aged 6-23 months.…”

Geographical variations of food insecurity and its associated factors in Bangladesh: Evidence from pooled data of seven cross-sectional surveys

“…Our estimated minimum sample size was 192 households per district for caregivers of 6-59-month-old children. The detailed sample size calculation was presented in other papers of this project [19,20]. For this article, we pooled data from seven surveys since the first survey of MIYCN did not include all the food insecurity indicators.…”