81374 enGender Impact: The World Bank’s Gender Impact Evaluation Database Improving Nutritional Status through Behavioral Change: Lessons from Madagascar Author(s) Emanuela Galasso, Nithin Umapathi Contact egalasso@worldbank.org Country Madagascar Organizing Health Theme Status Completed Intervention Nutrition Category Sector Health, Nutrition & Population This paper provides evidence of the effects of a large-scale intervention that focuses on the quality of nutritional and child care inputs during the early stages of life. The empirical strategy uses a combination of double-difference and weighting estimators in a longitudinal survey to address the purposive placement of participating communities and estimate the effect of the availability of the program at the community level on nutritional outcomes. The authors find that the program helped 0-5 year old children in the participating communities to bridge the gap in weight for age z- scores and the incidence of underweight. The program also had significant effects in protecting long-term nutritional Abstract outcomes (height for age z-scores and incidence of stunting) against an underlying negative trend in the absence of the program. Importantly, the effect of the program exhibits substantial heterogeneity: gains in nutritional outcomes are larger for more educated mothers and for villages with better infrastructure. The program enables the analysis to isolate responsiveness to information provision and disentangle the effect of knowledge in the education effect on nutritional outcomes. The results are suggestive of important complementarities among child care, maternal education, and community infrastructure. Gender Gender Focused Intervention Connection Gender Gender disaggregated nutrition Outcomes IE Design Difference in Difference The program aims to improve the nutritional status of young children and pregnant mothers. On a monthly basis, community nutrition workers weigh all children under the age of 3 and provides counseling to mothers on the nutritional status of their children. The health worker may also do home visits if child growth is low or if the mother Intervention misses a session. The program also includes nutrition and hygiene education sessions that raise awareness of the importance of exclusive breastfeeding, the timing and composition of complementary food and on appropriate feeding practices and child care during illnesses. The program provides a micronutrient supplementation to both children under three and lactating and pregnant women. Intervention The program was gradually phased in starting in 1999 and expanded through early 2002. Period Sample The survey is nationally representative and was administered to approximately 14,000 households. 420 communities population were randomly drawn from each district. 35 households with at least one child aged 0-5 and/or a pregnant woman. Comparison The study compares individuals living in participating communities with individuals who live in non-participating conditions communities. Unit of Child Level analysis Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database Evaluation The baseline was conducted in 1997/1998, a midline was conducted in 2004 and an endline was conducted in 2007. Period The program significantly improved weight-for age z scores and reduced the proportion of children who were underweight. The program improved the weight-for -age z-score by .15-.22 standard deviations and reduced the Results incidence of underweight by 5.2-7.6 percentage points. The program also led to a significant reduction in stunting. The evidence suggests that these effects indicate significant impacts on longer-term nutritional outcomes. There is some heterogeneity in program impacts, more educated and wealthier mothers reap more benefits from the program. Primary study limitations Funding World Bank Research Grant Community Nutrition: Evaluation of Impacts in Africa Source Galasso, E., & Umapathi, N. (2009). Improving nutritional status through behavioral change: lessons from Madagascar. Reference(s) Journal of Development Effectiveness, 1(1), 60-85. Link to Studies http://www.tandfonline.com/doi/abs/10.1080/19439340902727669 Microdata http://microdata.worldbank.org/index.php/catalog/405, http://microdata.worldbank.org/index.php/catalog/294http://microdata.worldbank.org/index.php/catalog/405, http://microdata.worldbank.org/index.php/catalog/294 Last updated: 14 August 2013 2