ITP 2023 Project Proposal Formats & Guidelines
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Jef L Leroy, Deanna Olney, Marie Ruel - IFPRI
Micronutrient Forum, Cancun
•
October, 2016
PM2A
•
P
reventing
M
alnutrition in children
under
2
years of
A
ge
•
First 1,000 days
•
Three components:
–
Food rations:
Household ration + individual ration
(pregnant/lactating woman and child 6-23.9 mo)
–
Health services:
Antenatal care, postnatal care, immunizations,
micronutrient supplementation, other
preventive/curative health and nutrition services
–
Behavior change communication
(BCC):
Care and feeding practices, hygiene, and health
practices
Photo credit: Meghan Parker
Two studies: Guatemala and Burundi
•
Burundi is one of the world’s poorest countries
(UNDP
2013)
•
81% of the population lives on < $1.25/day
(World Bank,
2011)
; > 60% is food insecure
•
Region where study was carried out (central-eastern),
high stunting (62%)
(DHS 2010)
•
Country has been suffering from severe political and
economic instability for decades
Background: Burundi
•
Food-assisted MCHN programs:
–
Widely used in low and middle income countries to alleviate
the persistent problems of maternal and child
undernutrition.
–
Evidence of their impact on maternal and child health and
nutrition outcomes is scant, especially so for anemia
.
•
Anemia in Burundi
:
–
In 2011 the prevalence of anemia among pregnant women
and children under five were estimated at 31 and 47 %,
respectively.
–
Given the size of the problem and the multiple causes of
anemia that
Tubaramure
addresses (promotion of bednet
use, utilization of health services, provision of CSB, etc.), a
reduction of the prevalence of anemia would be expected.
Background
•
Estimate the impact of
Tubaramure
on Hb and
anemia among children aged 0 to 23.9 mo and their
mothers.
•
Explore the pathways of impact.
Objectives
Study setting
Intervention package
1
Values are for pregnancy & first 6 mo of lactation / 6 to 23.9 mo old children
•
cRCT with 2 cross-sectional surveys (2010-
2012)
•
Impact analysis: double difference
colline
-
fixed effect model, controlling for potential
confounding factors:
Controls for possible differences between groups at
baseline
•
Standard errors adjusted for clustering.
Design
•
Step 1
: impact on final outcomes of interest
•
Step 2
: impact on intermediary behaviors & practices
•
Step 3
: dose-response analysis
Child and
maternal Hb
and anemia
Tubaramure
Intermediary
outcomes
(diet, bednets,
etc)
Tubaramure
Child and
maternal Hb
and anemia
Intermediary
outcomes
(diet, bednets,
etc)
Analytic approach
Baseline characteristics
(0-23.9 months)
Data are mean±SD unless otherwise specified. * Significantly different (p<0.05) between study groups.
Child hemoglobin
(0-23.9 months)
Child hemoglobin
(0-23.9 months)
*
*
* Different
from 0, P<0.05
Other impacts in children
(0-23.9 mo)
Data are estimated impact ± SE
Pathways of impact
children
(0-23.9 mo)
Consumed CSB
Minimum dietary diversity
Consumed Fe-rich foods
Minimum meal frequency
Bed net use
Illness
Fever
PM2A
Child hemoglobin
•
Using a large scale cluster-randomized controlled
effectiveness trial:
–
We demonstrate impact of a food-assisted MCHN program
on child and maternal (not shown) hemoglobin and anemia.
–
We demonstrate impact on intermediary
variables (diet,
morbidity, bed net use), which suggests plausible pathways
of impact.
•
Marked increase in anemia (women and children)
from baseline to follow-up is of great concern.
•
Findings suggest that food-assisted MCHN programs
can protect poor families from economic or health
shocks in vulnerable countries such as Burundi.
Conclusions
Acknowledgements
•
The research took place within the USAID FFP-funded
Tubaramure
program, led by Catholic Relief Services in consortium with Food for the
Hungry, International Medical Corps, and Caritas Burundi. We thank the
consortium partners for overseeing and implementing the program and
for their collaboration with the research teams and processes.
•
Sources of financial support:
–
The study was made possible by the generous support of the American people
through the support of the Office of Food for Peace, Bureau for Democracy,
Conflict, and Humanitarian Assistance, and the Office of Health, Infectious
Diseases, and Nutrition, Bureau for Global Health, U.S. Agency for
International Development (USAID), under terms of Cooperative Agreement
No
.
AID-OAA-A-12-00005
,
through the Food and Nutrition Technical Assistance
III Project (FANTA), managed by FHI 360.
–
This study also received support from the CGIAR Research Program on
Agriculture for Nutrition and Health (A4NH), led by IFPRI
Engage in the upcoming session to gain insights into the new format for ITP project proposals. Explore FYP2 ambitions, higher education's role in sustainable development, and the integration of Global Citizenship. Get updated on the timeline and what's new for ITP 2023, aligning with the 2030 Agenda for Sustainable Development and VLIR-UOS revised Theory of Change.
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Presentation Transcript
Tubaramure Tubaramure, a food nutrition program in Burundi improves maternal nutrition program in Burundi improves maternal and child hemoglobin levels and reduces anemia: a and child hemoglobin levels and reduces anemia: a theory theory- -based cluster based cluster- -randomized controlled randomized controlled intervention trial intervention trial Jef L Leroy, Deanna Olney, Marie Ruel - IFPRI , a food- -assisted integrated health and assisted integrated health and Micronutrient Forum, Cancun October, 2016
PM2A Preventing Malnutrition in children under 2 years of Age First 1,000 days Three components: Food rations: Household ration + individual ration (pregnant/lactating woman and child 6-23.9 mo) Health services: Antenatal care, postnatal care, immunizations, micronutrient supplementation, other preventive/curative health and nutrition services Behavior change communication (BCC): Care and feeding practices, hygiene, and health practices Photo credit: Meghan Parker
Background: Burundi Burundi is one of the world s poorest countries (UNDP 2013) 81% of the population lives on < $1.25/day (World Bank, 2011); > 60% is food insecure Region where study was carried out (central-eastern), high stunting (62%) (DHS 2010) Country has been suffering from severe political and economic instability for decades
Background Food-assisted MCHN programs: Widely used in low and middle income countries to alleviate the persistent problems of maternal and child undernutrition. Evidence of their impact on maternal and child health and nutrition outcomes is scant, especially so for anemia. Anemia in Burundi: In 2011 the prevalence of anemia among pregnant women and children under five were estimated at 31 and 47 %, respectively. Given the size of the problem and the multiple causes of anemia that Tubaramure addresses (promotion of bednet use, utilization of health services, provision of CSB, etc.), a reduction of the prevalence of anemia would be expected.
Objectives Estimate the impact of Tubaramure on Hb and anemia among children aged 0 to 23.9 mo and their mothers. Explore the pathways of impact.
Study setting http://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/Burundi_Provinces.png/250px-Burundi_Provinces.png
Intervention package Study Arms 3 Treatment Groups Control Family food ration (monthly) 12.0 CSB, kg 1.2 Vegetable oil, kg Individual food ration (monthly)1 6.0 / 3.0 CSB, kg 0.6 / 0.3 Vegetable oil, kg BCC (care groups; meet twice/month) Yes Access to government health services Yes Yes 1Values are for pregnancy & first 6 mo of lactation / 6 to 23.9 mo old children
Design cRCT with 2 cross-sectional surveys (2010- 2012) Impact analysis: double difference colline- fixed effect model, controlling for potential confounding factors: Controls for possible differences between groups at baseline Standard errors adjusted for clustering.
Analytic approach Step 1: impact on final outcomes of interest Child and maternal Hb and anemia Tubaramure Step 2: impact on intermediary behaviors & practices Intermediary outcomes (diet, bednets, etc) Tubaramure Step 3: dose-response analysis Intermediary outcomes (diet, bednets, etc) Child and maternal Hb and anemia
Baseline characteristics (0-23.9 months) Study arm Full sample 2,622 Treatment Control 1,733 889 N Household Size Head has no education/preschool, % Head farms, % Mother Age, y Has no education/preschool, % Child Age, m Stunted, % Wasted, % 5.6 2.0 40.3 76.3 5.6 2.0 39.6 75.4 5.5 2.0 41.6 78.0 28.6 7.0 51.8 28.7 7.0 50.8 28.3 7.1 53.7 12.8 6.8 53.3 7.2 12.6 6.8 51.8 7.5 13.2 6.8 56.1 6.7 Data are mean SD unless otherwise specified. * Significantly different (p<0.05) between study groups.
Child hemoglobin (0-23.9 months) All 0 to 5.9 mo Impact on Hb (g/dL) 6 to 23.9 mo Unadjusted Hb (g/dL) 11.00 11.0 10.70 10.60 10.60 10.70 10.60 10.20 10.50 10.10 10.30 10.0 9.80 9.70 0.5 0.43 0.38 0.4 0.3 0.2 0.14 0.1 0.0 2010 2012 2010 2012 2010 2012 wave Control Treatment Impact (95% CI)
Child hemoglobin (0-23.9 months) All 0 to 5.9 mo Impact on Hb (g/dL) 6 to 23.9 mo Unadjusted Hb (g/dL) 11.00 11.0 10.70 10.60 10.60 10.70 10.60 10.20 10.50 10.10 10.30 10.0 9.80 9.70 0.5 0.43 * 0.38 * 0.4 0.3 0.2 0.14 0.1 0.0 2010 2012 2010 2012 2010 2012 wave Control Treatment Impact (95% CI) * Different from 0, P<0.05
Other impacts in children (0-23.9 mo) Outcome Infant and young child feeding (last 24 h) Consumed CSB, % Minimum dietary diversity (with CSB), % Minimum dietary diversity (without CSB), % Consumed Fe-rich foods (with CSB), % Consumed Fe-rich foods (without CSB), % Minimum meal frequency, % Bed net use (last 24 h) All, % 0 to 5.9 mo, % 6 to 23.9 mo, % Morbidity (last 2 wk) Any illness, all, % Fever, all, % Impact Significant? 43.5 3.1 11.2 3.7 7.0 4.1 35.0 3.4 2.4 2.6 12.9 3.9 * * * * * 2.2 4.3 23.0 5.9 -2.8 4.4 * -9.4 3.4 -10.8 2.9 * * Data are estimated impact SE
Pathways of impact children(0-23.9 mo) Consumed CSB Minimum dietary diversity Consumed Fe-rich foods PM2A Child hemoglobin Minimum meal frequency Bed net use Illness Fever
Conclusions Using a large scale cluster-randomized controlled effectiveness trial: We demonstrate impact of a food-assisted MCHN program on child and maternal (not shown) hemoglobin and anemia. We demonstrate impact on intermediary variables (diet, morbidity, bed net use), which suggests plausible pathways of impact. Marked increase in anemia (women and children) from baseline to follow-up is of great concern. Findings suggest that food-assisted MCHN programs can protect poor families from economic or health shocks in vulnerable countries such as Burundi.
Acknowledgements The research took place within the USAID FFP-funded Tubaramure program, led by Catholic Relief Services in consortium with Food for the Hungry, International Medical Corps, and Caritas Burundi. We thank the consortium partners for overseeing and implementing the program and for their collaboration with the research teams and processes. Sources of financial support: The study was made possible by the generous support of the American people through the support of the Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, and the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, U.S. Agency for International Development (USAID), under terms of Cooperative Agreement No. AID-OAA-A-12-00005, through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360. This study also received support from the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by IFPRI
