An evaluation of the impact of a US$60 million nutrition programme in Bangladesh

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 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. RESULTS: 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. 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.