A Follow-up Study on the Sustained Impact of Alive & Thrive Interventions on Infant and Young Child Feeding Practices
Condition: Breastfeeding; Complementary Feeding
Study type: Interventional

Summary: 
      Alive & Thrive (A&T) is a multi-year initiative to improve infant and young child feeding
      (IYCF) practices. During Phase 1 (A&T-1, 2009-2014), funded by the Bill & Melinda Gates
      Foundation, A&T aimed to reduce undernutrition and death caused by suboptimal IYCF practices
      in three countries - Bangladesh, Ethiopia, and Viet Nam.

      In 2014, IFPRI in collaboration with DATA conducted the endline survey in Bangladesh. The
      overall findings of the evaluation indicate that A&T's work in Bangladesh is a remarkable
      success story of scaling up what has been challenging to date in the field of nutrition:
      complex, high intensity and at-scale behavior change communications interventions.

      In 2016, a follow up study will be conducted to determine the sustained impacts on IYCF
      practices, expansion of operations and promoted practices into new areas, and diffusion of
      IYCF information, two years after the termination of external project support.
    

Detailed description: 
      Alive & Thrive (A&T) is a multi-year initiative to improve infant and young child feeding
      (IYCF) practices. During Phase 1 (A&T-1, 2009-2014), funded by the Bill & Melinda Gates
      Foundation, A&T aimed to reduce undernutrition and death caused by suboptimal IYCF practices
      in three countries - Bangladesh, Ethiopia, and Viet Nam.

      A&T-1 strategies in Bangladesh were designed to support improvements in IYCF in three key
      ways: 1) improving policy and regulatory environments (advocacy); 2) shaping IYCF demand and
      practice (community-based interventions); and 3) increasing supply, demand, and use of high
      quality complementary foods (private sector engagement). In addition, a communications
      component was integrated into each of these focus areas to support their activities.

      In 2014, IFPRI in collaboration with DATA conducted the endline survey. The overall findings
      of the evaluation indicate that A&T's work in Bangladesh is a remarkable success story of
      scaling up what has been challenging to date in the field of nutrition: complex, high
      intensity and at-scale behavior change communications interventions. This is demonstrated by
      a series of findings on reach of the interpersonal counseling interventions and the mass
      media, as well as attributable improvements in several critical indicators. During the
      intervention period, A&T facilitated the training of over 75,000 frontline workers and health
      providers across the country. The program model reached large scale with an estimated 1.7
      million mothers of children under 2 years in 50 sub-districts. The mass media intervention
      operated at a national level and through national television channels. Compared to the 2010
      baseline survey, improvements were seen in several key IYCF practices that are attributable
      to A&T intensive package of interventions. Specifically, large significant impacts were seen
      on two key breastfeeding indicators: EBF (DID impact estimates: 36.9 percentage point-pp) and
      early initiation of BF (DID 19.4 pp). Similarly, large significant impact were seen in
      minimum dietary diversity (DID 16.3 pp), minimum meal frequency (DID 14.7 pp), minimum
      acceptable diet (DID 22.0 pp), and consumption of iron rich food (DID 24.6 pp).

      In 2016, a follow up study will be conducted to determine the sustained impacts on IYCF
      practices, expansion of operations and promoted practices into new areas, and diffusion of
      IYCF information, two years after the termination of external project support. Because
      achievements related to service delivery and outcomes are intended to be sustained in the
      intervention areas and even expanded to other areas where BRAC's Essential Health Care
      program operates, including the comparison areas, this study aims to examine elements in both
      the original intervention and comparison areas.

      This study focuses on the follow-up survey of the BRAC community-based model. The study
      research questions include:

      Sustained impacts

        1. To what extent are IYCF knowledge and practices sustained in the intervention areas?

        2. To what extent is exposure to IYCF and nutrition behavior change communications
           sustained in the intervention areas?

      Expanded operations and reach 1) To what extent has exposure to IYCF and nutrition behavior
      change communications been expanded (i.e. in comparison areas)?

      Diffusion of information

      1) To what extent is IYCF information diffused through social networks or by other sources
      (i.e. other than BRAC frontline workers)?
    

Intervention name(s): Interpersonal behavioral change communication; Mass media
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This arm includes home visits to mothers with infants and young children. Frontline health workers will counsel and support mothers in relation to breastfeeding and complementary feeding practices; A nationwide mass media campaign of TV and radio spots on infant and young child feeding practices will be aired in 2011, 2012 and 2013. All intervention arms will be exposed to this campaign.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research