A Follow-up Study on the Sustained Impact of Alive & Thrive Interventions on Infant and Young Child Feeding Practices

A Follow-up Study on the Sustained Impact of Alive & Thrive Behavior Change Communication Interventions on Infant and Young Child Feeding Practices in Bangladesh

Alive & Thrive (A&T) is a multi-year initiative to improve infant and young child feeding (IYCF) practices. During Phase 1 (A&T-1, 2009-2014), funded by the Bill & Melinda Gates Foundation, A&T aimed to reduce undernutrition and death caused by suboptimal IYCF practices in three countries - Bangladesh, Ethiopia, and Viet Nam.

In 2014, IFPRI in collaboration with DATA conducted the endline survey in Bangladesh. The overall findings of the evaluation indicate that A&T's work in Bangladesh is a remarkable success story of scaling up what has been challenging to date in the field of nutrition: complex, high intensity and at-scale behavior change communications interventions.

In 2016, a follow up study will be conducted to determine the sustained impacts on IYCF practices, expansion of operations and promoted practices into new areas, and diffusion of IYCF information, two years after the termination of external project support.

Study Overview

• Status: Completed
• Conditions: Breastfeeding; Complementary Feeding
• Intervention / Treatment: Behavioral: Mass media; Behavioral: Interpersonal behavioral change communication

Detailed Description

Alive & Thrive (A&T) is a multi-year initiative to improve infant and young child feeding (IYCF) practices. During Phase 1 (A&T-1, 2009-2014), funded by the Bill & Melinda Gates Foundation, A&T aimed to reduce undernutrition and death caused by suboptimal IYCF practices in three countries - Bangladesh, Ethiopia, and Viet Nam.

A&T-1 strategies in Bangladesh were designed to support improvements in IYCF in three key ways: 1) improving policy and regulatory environments (advocacy); 2) shaping IYCF demand and practice (community-based interventions); and 3) increasing supply, demand, and use of high quality complementary foods (private sector engagement). In addition, a communications component was integrated into each of these focus areas to support their activities.

In 2014, IFPRI in collaboration with DATA conducted the endline survey. The overall findings of the evaluation indicate that A&T's work in Bangladesh is a remarkable success story of scaling up what has been challenging to date in the field of nutrition: complex, high intensity and at-scale behavior change communications interventions. This is demonstrated by a series of findings on reach of the interpersonal counseling interventions and the mass media, as well as attributable improvements in several critical indicators. During the intervention period, A&T facilitated the training of over 75,000 frontline workers and health providers across the country. The program model reached large scale with an estimated 1.7 million mothers of children under 2 years in 50 sub-districts. The mass media intervention operated at a national level and through national television channels. Compared to the 2010 baseline survey, improvements were seen in several key IYCF practices that are attributable to A&T intensive package of interventions. Specifically, large significant impacts were seen on two key breastfeeding indicators: EBF (DID impact estimates: 36.9 percentage point-pp) and early initiation of BF (DID 19.4 pp). Similarly, large significant impact were seen in minimum dietary diversity (DID 16.3 pp), minimum meal frequency (DID 14.7 pp), minimum acceptable diet (DID 22.0 pp), and consumption of iron rich food (DID 24.6 pp).

In 2016, a follow up study will be conducted to determine the sustained impacts on IYCF practices, expansion of operations and promoted practices into new areas, and diffusion of IYCF information, two years after the termination of external project support. Because achievements related to service delivery and outcomes are intended to be sustained in the intervention areas and even expanded to other areas where BRAC's Essential Health Care program operates, including the comparison areas, this study aims to examine elements in both the original intervention and comparison areas.

This study focuses on the follow-up survey of the BRAC community-based model. The study research questions include:

Sustained impacts

1. To what extent are IYCF knowledge and practices sustained in the intervention areas?
2. To what extent is exposure to IYCF and nutrition behavior change communications sustained in the intervention areas?

Expanded operations and reach 1) To what extent has exposure to IYCF and nutrition behavior change communications been expanded (i.e. in comparison areas)?

Diffusion of information

1) To what extent is IYCF information diffused through social networks or by other sources (i.e. other than BRAC frontline workers)?

• Study Type: Interventional
• Enrollment (Actual): 2400
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • District of Columbia
    • Washington, District of Columbia, United States, 20006
      • International Food Policy Research Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 43 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Women with children <24 months of age

Exclusion Criteria:

• Age <18
• Mental disorders that cannot understand and answer the questions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Non-intensive group; Essential Health Care (EHC) only This arm is the basic comparison arm, which will receive the standard package of health services offered through BRAC's essential health care (basic antenatal care, basic counseling on health and nutrition through health worker home visits. In addition, a nationwide mass media campaign on IYCF practices will ensure exposure to some messages about IYCF behaviors in this arm.	Behavioral: Mass media; A nationwide mass media campaign of TV and radio spots on infant and young child feeding practices will be aired in 2011, 2012 and 2013. All intervention arms will be exposed to this campaign.
Experimental: Intensive group; Interpersonal behavioral change communication This arm will have a behavior change communications intervention to improve infant and young child feeding practices. The intervention will be delivered primarily by the frontline health workers who will visit mothers in their homes and counsel them on essential IYCF practices. In addition, a nationwide mass media campaign on IYCF practices will ensure exposure to some messages about IYCF behaviors in this arm.	Behavioral: Mass media; A nationwide mass media campaign of TV and radio spots on infant and young child feeding practices will be aired in 2011, 2012 and 2013. All intervention arms will be exposed to this campaign.; Behavioral: Interpersonal behavioral change communication; This arm includes home visits to mothers with infants and young children. Frontline health workers will counsel and support mothers in relation to breastfeeding and complementary feeding practices

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exclusive breastfeeding (EBF) among children 0-6 months of age	The proportion of infants less than 6 months who have been exclusively breastfed on the day preceding the interview	2 years after endline
Early initiation of breastfeeding	The proportion of newborns aged less than 24 months who were breastfed within 1 hour of birth.	2 years after endline
Complementary feeding among children 6-23.9 months of age	Complementary feeding indicators that include timely introduction of complementary foods (infants 6-8 months), dietary diversity (consumed at least 4 food groups), minimum meal frequency, will be measured using questionnaire.	2 years after endline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Extension of exposure to IYCF and nutrition behavioral change communication	Proportion of mothers with children <2 years exposed to IYCF and nutrition messages	2 years after endline
Diffusion of IYCF information though social network	Number of sources that provide IYCF information or messages	2 years after endline
Knowledge of infant and young child feeding	Proportion of mothers report correct knowledge on breastfeeding and complementary feeding based on questionnaire	2 years after endline

Collaborators and Investigators

• Sponsor: International Food Policy Research Institute
• Collaborators: FHI 360

Publications and helpful links

General Publications

• Nguyen PH, Frongillo EA, Kim SS, Zongrone AA, Jilani A, Tran LM, Sanghvi T, Menon P. Information Diffusion and Social Norms Are Associated with Infant and Young Child Feeding Practices in Bangladesh. J Nutr. 2019 Nov 1;149(11):2034-2045. doi: 10.1093/jn/nxz167.
• Kim SS, Nguyen PH, Tran LM, Sanghvi T, Mahmud Z, Haque MR, Afsana K, Frongillo EA, Ruel MT, Menon P. 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. J Nutr. 2018 Oct 1;148(10):1605-1614. doi: 10.1093/jn/nxy147.

Study record dates

Study Major Dates

• Study Start: April 1, 2016
• Primary Completion (Actual): June 1, 2016
• Study Completion (Actual): November 1, 2016

Study Registration Dates

• First Submitted: April 7, 2016
• First Submitted That Met QC Criteria: April 12, 2016
• First Posted (Estimate): April 15, 2016

Study Record Updates

• Last Update Posted (Actual): October 16, 2019
• Last Update Submitted That Met QC Criteria: October 14, 2019
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: IFPRI_1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided