(P18-032-23) Effectiveness of Specialized Nutritious Foods and Social and Behavior Change Communication Interventions To Prevent Stunting Among Children in Badakhshan, Afghanistan

Objectives: To assess the effectiveness of specialized nutritious food (SNF) and social and behavior change communication (SBCC) strategies to prevent stunting among children under 2 years during the first 1,000 days of life in Badakhshan, Afghanistan.

Methods: We used a quasi-experimental pre-post study design with a control group. Cross-sectional baseline and endline surveys were conducted to evaluate the study outcomes. A monthly ration of 7.5 kg of Super Cereal (250g/day) was received by pregnant and lactating women during pregnancy and first 6 months of lactation. Children aged 6-23 months received 30 sachets of lipid-based nutrient supplement medium-quantity (50g/sachet/day) on monthly basis. We compared pre- and post-intervention assessments of the intervention and control groups to isolate the effect of the intervention on key study outcomes at endline by difference-in-differences (DID) estimates.

Results: A total of 2,928 and 3,205 households were surveyed at baseline and endline. DID estimates adjusted for child, maternal and household characteristics indicated a significant reduction in stunting (DID: -5%; p=0.041) and underweight (DID: -4.6%; p=0.028) among children < 2 years of age. However, DID estimates were not significantly different for wasting among children in the intervention and control groups (DID: -1.7; p=0.315). Additional analyses suggest that exposure to the SBCC messages was associated with improvements in multiple IYCF practices, including early initiation of breastfeeding (DID: 19.6%, p< 0.001), exclusive breastfeeding for children under 6 months (DID: 11.0%, p=0.014), minimum meal frequency (DID: 23%, p< 0.001), minimal acceptable diet (DID: 13%, p< 0.001), and whether a child was ever breastfed (DID: 4.7%, p< 0.001).

Conclusions: The provision of SNF in combination with SBCC during the first 1,000 days of life were associated with improvements in several key outcomes including reductions in stunting and underweight and improvements in IYCF practices among children under 2 years of age. Findings from this study have important implications for policy development and intervention programmes to combat undernutrition during the first 1,000 days of life.

Funding Sources: World Food Programme, Afghanistan