The Bangladesh Integrated Nutrition Project sought to improve the nutritional status of children through counselling and supplementary feeding for malnourished children and women. Such programmes often assume that increased knowledge and resources result in the desired outcomes, but it is crucial to examine the underlying logic.

Child malnutrition levels in Bangladesh are amongst the highest in the world. The Bangladesh Integrated Nutrition Project (BINP), launched in 1995 and covering 12 percent of the population, aimed to improve the nutritional and health status of pre-school children, pregnant women and nursing mothers. Research published by the World Bank in the USA, and the Institute of Development Studies in the UK, evaluates the programme in terms of actual outcomes and plans to replicate it nationally.

The Community-Based Nutrition Component (CNBC) was the main part of the BINP. The CNBC gave pregnant women and nursing mothers nutritional counselling and offered food supplements to severely malnourished children and malnourished pregnant women. All children under two were to be covered by monthly growth monitoring.

The success of the CNBC depended on a chain of events from inputs to anticipated impacts. If the right people were targeted, they would learn about and apply good nutritional practices. Similarly, if adequate supplementary feeding reached the target groups, nutritional status would improve.

The authors found that:

• The project’s nutritional messages were too narrowly targeted to mothers, neglecting husbands and mothers-in-law.
• Though enrolment in growth monitoring sessions was high, targeting was poor, and attendance did not provide adequate opportunities for nutritional counselling.
• Knowledge of good nutritional practices is higher in the project areas but is not universal because of poor targeting, failure to spread messages and participant failure to learn.
• The project reduced malnutrition by less than two percent, far less than planned.
• Supplementary feeding was much more effective for malnourished children, especially during seasonal food shortages.
• Feeding pregnant women (especially poor women) had a slight impact on increasing birth weights, partly because the practice of eating less during pregnancy was targeted.

Apart from problems of targeting, there was a gap between improved knowledge and actual practices. Also, the BINP’s impact decreased over time. This could be due to the difficulty of maintaining good implementation over time, or even because improved nutrition across Bangladesh overshadowed the BINP’s impact in project areas.

The authors recommend improvements to the ‘weak links’ in the chain of events outlined above:

• Targeting for supplementary feeding for children could be improved by broadening eligibility and providing further training in interpreting growth charts.
• Supplementary feeding for women should focus more on pre-pregnancy weight and the most malnourished women.
• Feeding programmes should focus on periods of shortage.
• The gap between knowledge and practice can be addressed by considering resource constraints (such as a lack of time) and by involving husbands and mothers-in-law.
• Scaling up the project will be costly if it cannot be made more efficient - other ways to spread good practices should be considered, tailored to different groups.

Source(s):
‘Assessing Interventions to Improve Child Nutrition: A Theory-based Impact Evaluation of the Bangladesh Integrated Nutrition Project’, Journal of International Development, in press, by Howard White and Edoardo Masset, 2007

id21 Research Highlight: 15 February 2008

Further Information:
Howard White
Independent Evaluation Group
World Bank
1818 H Street
Washington DC, 20433
USA

Tel: +202 4733515
Fax: +202 4776391
Contact the contributor: hwhite@worldbank.org

World Bank

Edoardo Masset
Institute of Development Studies
University of Sussex
Falmer, Brighton, BN1 9RE
UK

Contact the contributor: e.masset@ids.ac.uk

Institute of Development Studies (IDS), UK

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