The United States Agency for International Development (USAID) spends nearly US$100 million a year on food-assisted child health and nutrition programmes, which aim to reduce food insecurity and childhood undernutrition. These programmes usually target services to families with children younger than 5 years who are identified through growth monitoring activities as underweight. However, previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition.
Research evidence suggests that a preventive approach based on targeting nutrition interventions as early as possible in children’s lives might be more effective than recuperation to reduce childhood undernutrition. Published studies on the process and timing of growth faltering, and on the effectiveness of food supplementation, provide convincing evidence that the first 2 years of life (in addition to the prenatal period) is the window of opportunity for nutritional interventions. This period is not only the time of greatest vulnerability and risk of possibly irreversible long-term physical and mental damage, but is also the period of greatest benefits from nutrition interventions.
The study was undertaken in the context of a new 5-year programme implemented by World Vision-Haiti in the Central Plateau region of Haiti, where World Vision operates in all 12 communes and serves a population of roughly 600,000. The programme offers a range of services for pregnant and lactating women and for children 0-59 months of age, and is based on five contact points between programme staff and beneficiaries. The maternal and child health services offered at rally posts are open to all community members, while food assistance is targeted only to pregnant and lactating women and to children identified as underweight.
The study compared two different models of targeting food assistance to children and the behaviour change and communication intervention to their mothers at the mothers’ clubs: the traditional, recuperative model, which targets underweight children (weight-for-age Z scores <–2) 6-59 months of age, and provides them with food assistance for 9 months; and the preventive model, which targets all children 6-23 months and provides up to 18 months of food assistance to children. The two programme models offer exactly the same services to pregnant and lactating women and to children at the rally posts and in home visits, and provide the same monthly food ration conditional on monthly attendance at rally posts and mothers' clubs.
The study used a cluster randomised trial to compare the two programme models, with 20 clusters of communities paired on access to services and other factors and randomly assigned to each model. The study tested differences in undernutrition in children aged 12-41 months, with analyses by intention-to-treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. The study found that the preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model, with stunting, underweight, and wasting 4-6 percentage points lower in preventive than in recuperative communities.