Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC.
Alive & Thrive, FHI 360, Hanoi, Vietnam.
J Nutr. 2018 Oct 1;148(10):1605-1614. doi: 10.1093/jn/nxy147.
Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010-2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity.
We assessed changes in intervention exposure and IYCF knowledge and practices in the intensive (IPC + CM + MM) compared with nonintensive areas (standard nutrition counseling + less intensive CM and MM) 2 y after termination of initial external donor support.
We used a cluster-randomized design with repeated cross-sectional surveys at baseline (2010, n = 2188), endline (2014, n = 2001), and follow-up (2016, n = 2400) in the same communities, among households with children 0-23.9 mo of age. Within-group differences over time and differences between groups in changes were tested.
In intensive areas, exposure to IPC decreased slightly between endline and follow-up (88.9% to 77.2%); exposure to CM activities decreased significantly (29.3% to 3.6%); and MM exposure was mostly unchanged (28.1-69.1% across 7 TV spots). Exposure to interventions did not expand in nonintensive areas. Most IYCF indicators in intensive areas declined from endline to follow-up, but remained higher than at baseline. Large differential improvements of 12-17 percentage points in intensive, compared with nonintensive areas, between baseline and follow-up remained for early initiation of and exclusive breastfeeding, timely introduction of foods, and consumption of iron-rich foods. Differential impact in breastfeeding knowledge remained between baseline and follow-up; complementary feeding knowledge increased similarly in both groups.
Continued IPC exposure and sustained impacts on IYCF knowledge and practices in intensive areas indicated lasting benefits from A&T's interventions as they underwent major scale-up with reduced intensity. This trial was registered at clinicaltrials.gov as NCT02740842.
婴儿和幼儿喂养（IYCF）的持续改善需要持续实施有效的干预措施。从 2010 年至 2014 年，Alive & Thrive（A&T）在孟加拉国提供了强化人际咨询（IPC）、社区动员（CM）和大众媒体（MM），并证明了这些干预措施对 IYCF 实践的影响。自 2014 年以来，国家合作伙伴在其他捐助者的支持下继续扩大和扩大实施规模，并进行了一些修改，例如更加关注孕产妇营养，并减少了方案的强度。
我们评估了在初始外部捐助者支持终止后 2 年，与非强化地区（标准营养咨询+较少强化的 CM 和 MM）相比，强化地区（IPC+CM+MM）的干预接触和 IYCF 知识和实践的变化。
我们使用了一个群组随机设计，在同一社区中对 0-23.9 个月大的儿童家庭进行了基线（2010 年，n=2188）、终线（2014 年，n=2001）和随访（2016 年，n=2400）的重复横断面调查。对随时间的组内差异和组间变化进行了检验。
在强化地区，IPC 的接触率在终线和随访之间略有下降（从 88.9%降至 77.2%）；CM 活动的接触率显著下降（从 29.3%降至 3.6%）；而 MM 的接触率基本不变（7 个电视广告的接触率在 28.1%至 69.1%之间）。非强化地区的干预措施没有扩大。强化地区的大多数 IYCF 指标从终线到随访都有所下降，但仍高于基线。与基线相比，强化地区的母乳喂养和纯母乳喂养的起始时间、及时引入固体食物以及摄入富含铁的食物等方面的改善幅度分别为 12-17 个百分点，仍然存在较大差异。母乳喂养知识的差异在基线和随访之间仍然存在；两组的补充喂养知识都有类似的增加。
强化地区 IPC 的持续接触和对 IYCF 知识和实践的持续影响表明，A&T 的干预措施在经历了大规模扩大规模和降低强度的过程后，仍具有持久的效益。这项试验在 clinicaltrials.gov 上注册为 NCT02740842。
