Preventing Child Wasting: Generating evidence on the impact of multi-sectoral programming and wasting seasonality in Goz Beida, Chad
Marshak, Anastasia.
2021
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Thesis
(Ph.D.)--Tufts University, 2021.
Submitted to the Dept. of Food and Nutrition Policy and Programs.
Advisor: Elena Nuamova.
Committee: Helen Young, and Edward Saltzman.
Keyword: Nutrition.
Introduction: Efforts on wasting have been slow with wasting prevalence in some contexts exceeding the emergency threshold of 15% even without a humanitarian ... read moreemergency. The overall aim of this research is to contribute to our understanding of wasting prevention. The research looks at the impact and sustainability of multisectoral programming and the temporal distribution of wasting, helping our understanding of what programs needs to be put in place and when. Across all three studies the research focuses on children (6-59 months) in eastern Chad. Specific Aim 1: The research looks at the sensitivity of seven nutrition indicators to a multisectoral intervention and different analysis approaches using panel data (2012, 2014, 2015) on 1420 households from a randomized control study. Using three regression models - a generalized linear model on cross-sectional cohorts of children; a mixed-effects model on household panel data following the worst-off child in the household; and a mixed-effects model on child panel data - the study found that children receiving the intervention had better nutrition outcomes. The child panel analysis showed the most robust results: the odds of a child being severely wasted was 76% lower (CI: 0.59-0.86, p=0.001), the odds of being underweight was 33% lower (CI: 0.15-0.48, p=0.012), and the weight for height z-score (WHZ) was 0.19 standard deviations higher (CI: 0.09-0.28, p=0.022) in the treatment versus control group. The study provides evidence for multisectoral interventions to tackle wasting and the value of panel child data. Specific Aim 2: This research follows the same households evaluated in specific aim 1, but with a focus on the treatment communities two years (2017) after the cessation of the multisectoral intervention to evaluate program impact sustainability. The research uses the same three regression models as described under specific aim 1 across six nutrition indicators on 517 children between 2015 and 2017. For children who were born during the program, there was a significant improvement in underweight, weight for age z-score (WAZ), and height for age z-score (HAZ). Boys 6-23 months born after the end of the program, on the other hand, were significantly more likely to be underweight or wasted, and had lower WHZ and WAZ compared to boys born during the program and girls born during and after the program. Thus, while program impact is sustainable on the child level, it is not on the household level, with children born into intervention households, but not the intervention itself showing worse nutritional outcomes. The research findings underscore the importance of sex-differentiation in programming and analysis. Specific Aim 3: The research looks at a small subset of the households evaluated in the previous specific aims but focusing on the temporal distribution in wasting. The research uses 16 months of data (May 2018-August 2019) following 188 children (6-59 months) across 90 households applying a mixed-effects harmonic regression on WHZ and the odds of being wasted, testing for multiple and non-symmetrical seasonal peaks. The analysis shows two peaks of wasting. The primary larger peak occurs at the start of the rains, while the secondary smaller peak corresponds to the start of the harvest period. This pattern does not correspond to existing seasonality literature in unimodal dryland contexts and thus illustrates the importance of testing for multiple within-year peaks rather than resting on the assumption of one, and aligning seasonality analysis with inter-year climatic variability and grounding it in local understanding.read less - ID:
- x633ff795
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