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Impact Data - Alive & Thrive (A&T) in Bangladesh

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"A greater proportion of women practiced the recommended behaviors when they had face to face contact with frontline workers plus mass media (TV spots) than did women who only saw the TV spots."
 

From 1994 to 2007, the exclusive breastfeeding rate in Bangladesh hovered between 42 and 46 percent (Demographic and Health Surveys (DHS) 2004, 2007, and 2011). Although declining, high rates of infant deaths and stunted growth persisted. In this context, Alive & Thrive (A&T) designed a comprehensive framework in 2009 to scale up breastfeeding and complementary feeding practices - proven interventions for reducing child mortality and morbidity and ensuring healthy growth and development. Launched in Bangladesh, Vietnam, and Ethiopia with funding from Bill and Melinda Gates Foundation and Canadian and Irish governments, A&T used advocacy, interpersonal communication and community mobilisation, mass media, and strategic data to improve breastfeeding and complementary feeding practices and to reduce stunting and anaemia in young children. (see Related Summaries, below).

Methodologies

A baseline and an endline survey were conducted in 2010 and 2014 respectively in 50 upazilas (subdistricts) where A&T was implemented.

Practices

Rapid improvements in breastfeeding and complementary feeding practices:

  • Increased timely initiation of breastfeeding from 64 to 94 percent
  • Increased exclusive breastfeeding from 48 to 88 percent
  • Increased timely introduction of solid and semi-solid foods from 46 to 99 percent
  • Increased dietary diversity from 32 to 64 percent
  • Increased minimum meal frequency from 42 to 75 percent
  • Increased minimum acceptable diet from 16 to 50 percent
  • The percentage of mothers washing hands before feeding young children improved from 23 to 31 percent.

Nationally, the latest Demographic and Health Survey (DHS) in 2014 found 36 percent children under five in Bangladesh too short for their age, which was five percentage points lower than the 2011 survey. During the same period, the underweight rate also declined to 33 percent from 36 percent. The jump of exclusive breastfeeding rate to 64 percent in 2011 from a long 15-year plateau at around 45 percent has been largely credited to the mass media campaign of the A&T project.

Access
  • 1.7 million mothers of children under the age of 2 were counseled on IYCF in programe areas by more than 10,000 frontline workers of BRAC, the non-governmental organisation (NGO) responsible for implementing the interpersonal communication and community mobilisation components. Specifically, nearly 10,000 incentisized community health volunteers (Shasthya Shebika) and 1,000 paid IYCF promoters (Pushti Kormi) provided IYCF counseling, coaching, demonstrations, problem-solving, and referrals at scheduled intervals. In 2014, 90% of households in the programme areas reported having been visited by a BRAC worker.
  • More than 600 community health workers (Shasthya Kormi) discussed early initiation and exclusive breastfeeding during antenatal care (ANC) visits and provided support for good positioning and attachment. In a single month, over 35,000 mothers attended these ANC visits.
  • The community health workers included IYCF issues in small group discussions with pregnant women, mothers, and family members. In a single month, BRAC held 2,700 health and nutrition forums for women.
  • BRAC held half-day sessions for religious leaders, informal health care providers, fathers, traditional birth attendants, government health and family welfare staff, school teachers, adolescent girls, and other opinion leaders. In a single month, 3,000 local opinion leaders were reached through these meetings. Furthermore, the advocacy team "engaged in sustained dialogue with national leaders in different development sectors and disseminated key messages and evidence to stakeholders. Alive & Thrive also implemented a capacity building program for journalists and engaged policymakers, program managers, medical doctors, and journalists through national and district-level advocacy meetings and workshops."

A national mass media campaign (radio and TV spots) reached an estimated 8.5 million mothers of children under 2, in addition to fathers, grandmothers, and other members of society who influence feeding behaviours. In 2014, between 70 and 80 percent of households in A&T's programme areas reported viewing the TV spots, and between 58 and 68 percent of mothers could accurately recall the stories and/or messages in the TV spots.

Other Impacts

A&T collaborated with International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDRB) to develop and test a strategy to improve handwashing behaviours before child feeding. Following a series of qualitative and quantitative studies, and pretests with households and community workers, A&T added a handwashing component to the programme. Findings informed the development of a new communication and advocacy campaign and engaged new partners such as Bangladesh's Department of Public Health Engineering and stakeholders in water, sanitation, and hygiene. "The formation of a national IYCF Alliance was essential for expanding the number of implementing partners and facilitated the adoption of Alive & Thrive's approaches and tools well beyond the initial BRAC sub-districts."



Following the success of the above-described comprehensive infant young child feeding (IYCF) programme, A&T transitioned to a new phase of activities (September 2014 to September 2016) in Bangladesh. They have started collaborating with BRAC and other partners in 4 districts to integrate maternal nutrition interventions into maternal, neonatal, and child health (MNCH) programmes, as described in this 2-page brief, "Integrating maternal nutrition into maternal, neonatal, and child health programs in Bangladesh" [PDF].

Source

"Alive & Thrive's Approach and Results in Bangladesh: Rapid Improvements in Infant and Young Child Feeding Practices Resulting from a Large-Scale Program", August 24 2015 - sent via email from Alive & Thrive to The Communication Initiative on September 24 2015; and "Gates Foundation to Take Its Bangladesh Nutrition Project Lessons to Other Countries", by Nurul Islam Hasib, August 25 2015, bdnews24.com, "Breastfeeding Goes up by 40 Percent", The Daily Star, August 27 2015, and A&T Bangladesh website - all accessed on March 10 2016. Image credit: Shafiqul Alam Kiron | Alive & Thrive