Abstract

Objective: 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.

Methods: 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 6820 households (4554 in the project areas and 2266 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.

Results: 2388 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.

Conclusion: 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.

Author notes

1UNICEF, Islamabad, Pakistan and 2Save the Children UK, London, UK