Fighting child malnutrition through the Bangladesh Integrated Nutrition Project

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.

Childmalnutrition levels in Bangladesh are amongst the highest in the world. The BangladeshIntegrated Nutrition Project (BINP), launched in 1995 and covering 12 percentof the population, aimed to improve the nutritional and health status ofpre-school children, pregnant women and nursing mothers. Research published bythe World Bank in the USA, and the Institute ofDevelopment Studies in the UK, evaluates the programme in terms of actualoutcomes and plans to replicate it nationally.

TheCommunity-Based Nutrition Component (CNBC) was the main part of the BINP. TheCNBC gave pregnant women and nursing mothers nutritional counselling andoffered food supplements to severely malnourished children and malnourishedpregnant women. All children under two were to be covered by monthly growthmonitoring.

Thesuccess of the CNBC depended on a chain of events from inputs to anticipatedimpacts. If the right people were targeted, they would learn about and applygood nutritional practices. Similarly, if adequate supplementary feedingreached the target groups, nutritional status would improve.

Theauthors found that:

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

Apartfrom problems of targeting, there was a gap between improved knowledge andactual practices. Also, the BINP’s impact decreased over time. This could bedue to the difficulty of maintaining good implementation over time, or evenbecause improved nutrition across Bangladesh overshadowed the BINP’s impact in project areas.

Theauthors recommend improvements to the ‘weak links’ in the chain of eventsoutlined above:

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