Hossain S M Moazzem, Duffield Arabella, Taylor Anna
UNICEF, Islamabad, Pakistan.
Health Policy Plan. 2005 Jan;20(1):35-40. doi: 10.1093/heapol/czi004.
To compare levels of childhood malnutrition in areas where the Bangladesh Integrated Nutrition Project had been operational for over 5 years with matched non-project areas, with the purpose of evaluating whether the project had achieved its objective of reducing the prevalence of underweight among children <24 months.
The study involved an ex-post cross-sectional survey in six thanas (a locality with a population of approximately 200,000-450,000 people) in Bangladesh. Participants were 6,820 households (4,554 in the project areas and 2,266 in the non-project areas) including 7183 children aged 6-59 months selected using a two-stage stratified cluster sampling frame. Main outcome measures were moderate and severe underweight, wasting and stunting reported using z scores, and indicators of mothers' reported nutritional knowledge and practice.
2,388 children aged 6-23 months and 6815 children aged 6-59 months had clean anthropometric data. No significant difference was found between the socio-economic variables of households in the project and non-project areas. No significant difference was found in the prevalence of either severe or moderate underweight (weight-for-age) in children aged 6-23 months in the project and non-project areas: 183 (11.4%, 95% confidence interval 9.9-13.2%) children in project areas and 96 (12.2%, 95% confidence interval 9.9-14.8%) children in non-project areas. Mothers in project areas reported significantly better caring practices than in non-project areas.
There is no evidence that the Bangladesh Integrated Nutrition Project has achieved its objectives to reduce severe underweight by 40% if project areas are compared ex-post with non-project areas. There is urgent need to review the evidence behind investments based on growth monitoring and promotion.
比较孟加拉国综合营养项目实施超过5年的地区与匹配的非项目地区儿童营养不良水平,以评估该项目是否实现了降低24个月以下儿童体重不足患病率的目标。
该研究在孟加拉国的6个乡(人口约20万至45万的地区)进行了事后横断面调查。参与者为6820户家庭(项目地区4554户,非项目地区2266户),包括使用两阶段分层整群抽样框架选取的7183名6至59个月大的儿童。主要结局指标为使用z评分报告的中度和重度体重不足、消瘦和发育迟缓,以及母亲报告的营养知识和实践指标。
2388名6至23个月大的儿童和6815名6至59个月大的儿童有完整的人体测量数据。项目地区和非项目地区家庭的社会经济变量没有显著差异。项目地区和非项目地区6至23个月大儿童的重度或中度体重不足(年龄别体重)患病率没有显著差异:项目地区183名儿童(11.4%,95%置信区间9.9 - 13.2%),非项目地区96名儿童(12.2%,95%置信区间9.9 - 14.8%)。项目地区的母亲报告的护理实践明显优于非项目地区。
如果将项目地区与非项目地区进行事后比较,没有证据表明孟加拉国综合营养项目实现了将重度体重不足降低40%的目标。迫切需要审查基于生长监测和促进的投资背后的证据。