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Author : Beat Schürch,Nestlé Foundation
Publisher : Unknown
Page : 244 pages
File Size : 55,5 Mb
Release : 1983
Category : Diet
ISBN : CORNELL:31924002795205
Author : The World Bank
Publisher : World Bank Publications
Page : 168 pages
File Size : 45,9 Mb
Release : 2010-08-27
Category : Medical
ISBN : 0821384074
Evaluation Summary What Can We Learn from Nutrition Impact Evaluations? High levels of child malnutrition in developing countries contribute to mortality and have long-term consequences for children s cognitive development and earnings as adults. Recent impact evaluations show that many different interventions have had an impact on children s anthropometric outcomes (height, weight, and birth weight), but there is no simple answer to the question What works? to address the problem. Similar interventions have widely different results in different settings, owing to differences in local context, the causes and severity of malnutrition, and the capacity for program implementation. Impact evaluations of programs supported by the Bank, which are generally large-scale, complex inter-ventions in low-capacity settings, show equally variable results. The findings confirm that it should not be assumed that an intervention found effective in a randomized medical setting will have the same effects when implemented under field conditions. There are many robust experimental and quasi-experimental methods for assessing impact under difficult circumstances often found in field settings. The relevance and impact of nutrition impact evaluations could be enhanced by collecting data on service delivery, demand-side behavioral outcomes, and implementation processes to better understand the causal chain and what part of the chain is weak, in parallel with impact evaluations. It is also important to understand better the distribution of impacts, particularly among the poor, and to document better the costs and effectiveness of interventions. High levels of child malnutrition in developing countries are contributing to mortality and present long-term consequences for the survivors. An estimated 178 million children under age 5 in developing countries are stunted (low height for age) and 55 million are wasted (low weight for height). Malnutrition makes children more susceptible to illness and strongly affects child mortality. Beyond the mortality risk in the short run, the developmental delays caused by undernutrition affect children s cognitive outcomes and productive potential as adults. Micronutrient deficiencies vitamin A, iron, zinc, iodine, for example are also common and have significant consequences. Progress in reducing malnutrition has been slow: More than half of countries are not on track to achieve the Millennium Development Goal of halving the share of children who are malnou-rished (low weight for age) by 2015. The food price and financial crises are making achievement of this goal even more elusive. The World Bank has recently taken steps to ex-pand its support for nutrition in response to the underlying need and the increased urgency due to the crises. WHAT DO WE KNOW ABOUT REDUCING MALNUTRITION? The increased interest and resources focused on the problem of high and potentially increasing rates of undernutrition raises the question, what do we know about the causes of malnutrition and the in-terventions most likely to reduce it? The medical literature points to the need to inter-vene during gestation and the first two years of life to prevent child malnutrition and its consequences. It suggests that investments in interventions during this window of opportunity among children under 2 are likely to have the greatest benefits. Recently published meta-analyses of the impact evaluation literature point to several interventions found effective for reducing undernutrition in spe-cific settings. However, there are limitations to the generalizability of those reviews findings, particularly in the context of large-scale government programs most likely to be supported by the World Bank. The reviews tend to disproportionately draw on the findings of smaller, controlled experiments; there are few examples of evaluations of large-scale programs, over which there is less control in implementation. In reviewing a large number of studies, interventions, and outcomes, they tend to focus on average impacts. They generally do not explain the magnitude or variability of impacts across or within studies. Very few address the programmatic reasons why some interventions work or don t work, nor do they assess the cost-effectiveness of interventions. Objectives of the Review This paper reviews recent impact evaluations of interventions and programs to improve child anth-ropometric outcomes height, weight, and birth weight with an emphasis on both the findings and limitations of the literature and on understanding what might happen in a non-research setting. It further reviews in greater detail the experience and lessons from evaluations of the impact of World Bank-supported programs on nutrition outcomes. Specifically, the review addresses four questions. First, what can be said about the impact of different interventions on children s anthropometric outcomes? Second, how do these findings vary across settings and within target groups, and what accounts for this variability? Third, what is the evidence of the cost-effectiveness of these interventions? Finally, what have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? While there are different dimensions of child nutri-tion that could be explored, the report focuses on child anthropometric outcomes -- weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the MDGs. Methodology and Scope Forty-six nutrition impact evaluations published since 2000 were systematically reviewed. These evaluations assessed the impact of diverse interven-tions community nutrition programs, conditional and unconditional cash transfers, early child devel-opment programs, food aid, integrated health and nutrition services, and de-worming. All of the evaluations used research designs that compared the outcomes among those affected by the project to the counterfactual that is, what would have happened to a similar group of people in the absence of the intervention. About half used randomized assignment to create treatment and control groups, while the remainder used matching and various econometric techniques to construct a counterfactual. Among the 46 evaluations, twelve assessed the im-pact of World Bank-supported programs on nutri-tion outcomes in eight countries. While the broader review relies on the analysis of the published impact evaluations as the main source of data, for these twelve evaluations project documents and research outputs were reviewed and World Bank staff, country officials and the evaluators and re-searchers who conducted the studies were interviewed. Findings A wide range of interventions had a positive impact on indicators related to height, weight, wasting, and low birth weight. There were a total of 10 different outcome indica-tors for the four main anthropometric outcomes. A little more than half of the evaluations addressing a height-related indicator found program impacts on at least one group of children, and this was true for about the same share of interventions aimed at improving weight-related and wasting (low weight for height)-related indicators. About three-quarters of the 11 evaluations of interventions that aimed at improving birth weight indicators registered an impact in at least one specification, including five out of seven micronutrient interven-tions. There was no clear pattern of impacts across interventions in every intervention group there were examples of programs that did and did not have an impact on a given indicator, and with varying magnitude. Evaluations of the nutritional impact of programs supported by the World Bank, which are generally large-scale, complex, and implemented in low-capacity settings, show equally variable results. Even controlling for the specific outcome indicator, studies often targeted children of different age groups that might be more or less susceptible to the interventions. It is thus difficult to point to inter-ventions that are systematically more effective than others in reducing malnutrition across diverse set-tings and age groups. Differences in local context, variation in the age of the children studied, the length of exposure to the intervention, and differing methodologies of the studies account for much of the variability in results. Context includes factors like the level and local determinants of malnutrition, differences in the characteristics of beneficiaries (including their age), the availability of service infrastructure, and the implementation capacity of government. Outside of a research setting in the context of a large government program there are many things that can go wrong in either service delivery or the demand response that can compromise impact. Beyond this, there are social factors like the status of women or the presence of civil unrest that can affect outcomes. These findings underscore the conclusion that it should not be assumed that an intervention found effective in a randomized controlled trial in a re-search setting will have the same effects when im-plemented under field conditions in a different set-ting. They also point to the need to understand the prevailing underlying causes of malnutrition in a given setting and the age groups most likely to benefit in selecting an intervention. Further, impact evaluations need to supplement data measuring impact with data on service delivery and demand-side behavioral outcomes to demonstrate the plausibility of the findings, to understand what part of a program works, and to address weak links in the results chain to improve performance. There is scant evidence on the distribution of nutrition impacts who is benefiting and who is not or on the cost-effectiveness of interventions Just because malnutrition is more common among the poor does not mean that they will disproportio-nately benefit from an intervention, particularly if acting on new knowledge or different incentives relies on access to education or quality services. Only a third of the 46 evaluations looked at the distribution of impacts by gender, mother s education, poverty status, or availability of complementary health services. Only nine assessed the impacts on nutritional outcomes of the poor compared with the non-poor. Among the evaluations that did examine variation in results, several found that the children of more educated mothers or in better-off communities are be-nefitting the most. Bank-supported cash transfers, community nutrition, and early child development programs in six of eight countries had some impact on child anthropometric outcomes. Of the 12 impact evaluations of Bank support, all but one were of large-scale government programs with multiple interventions and a long results chain. Three-quarters found a positive impact on anthro-pometric outcomes of children in at least one age group, although the magnitude was in some cases not large or applied to a narrow age group. Most of the impact evaluations involved assessment of completely new programs and involved World Bank researchers. Most used quasi-experimental evaluation designs and two-thirds assessed impact after at most 3 years of program implementation. Only half of the evaluations documented the distribution of impacts and only a third presented information on the costs of the intervention (falling short of cost-effectiveness analysis). In two of the countries (Colombia and the Philippines) the evaluations likely had an impact on government policy or programs. Lessons A number of lessons for development practi-tioners and evaluators arose from the review of impact evaluations of World Bank nutrition support. For task managers: Impact evaluations of interventions that are clearly beyond the means of the government to sustain are of limited relevance. The complexity, costs, and fiscal sustainability of the intervention should figure into the decision as to whether an impact evaluation is warranted. Impact evaluations are often launched for the purpose of evaluating completely new pro-grams, but they may be equally or even more useful in improving the effectiveness of ongo-ing programs. There are methods for obtaining reliable impact evaluation results when randomized assignment of interventions is not possible for political, ethical, or practical reasons. For evaluators: In light of the challenges of evaluating large-scale programs with a long results chain, it is well worth the effort to assess the risks to disruption of the impact evaluation ahead of time and identify mitigation measures. The design and analysis of nutrition impact evaluations need to take into account the likely sensitivity of children of different ages to the intervention. For the purposes of correctly gauging im-pact, it is important to know exactly when delivery of an intervention took place in the field (as opposed to the official start of the program). Evaluations need to be designed to provide evidence for timely decision-making, but with sufficient elapsed time for a plausible impact to have occurred. The relevance of impact evaluations for po-licymakers would be greatly enhanced if im-pact evaluations were to document both the
Author : Norman J. Temple ,Nelia Steyn
Publisher : Athabasca University Press and UNISA Press
Page : 509 pages
File Size : 52,7 Mb
Release : 2016-03-31
Category : Medical
ISBN : 9781927356111
Nutrition textbooks used by universities and colleges in developing countries have very often been written by scholars who live and work in North America or the United Kingdom. And while the research and information they present is sound, the nutrition-related health challenges with which developing countries must grapple differ considerably from those found in highly industrialized Western nations. The primary aim of Community Nutrition for Developing Countries is to provide a book that meets the needs of nutritionists and other health professionals living and working in developing countries. Written by both scholars and practitioners, the volume draws on their wealth of knowledge, experience, and understanding of nutrition in developing countries to provide nutrition professionals with all the information they require. Each chapter addresses a specific nutrition challenge currently faced by developing countries such as food security, food safety, disease prevention, maternal health, and effective nutrition policy. In addition, the volume serves as an invaluable resource for those developing and implementing nutrition education programmes. With an emphasis on nutritional education as a means to prevent disease and effectively manage health disorders, it is the hope of the nearly three dozen contributors to this work that it will enhance the health and well-being of low-income populations throughout the world.
Author : Beat Schuerch
Publisher : Unknown
Page : 235 pages
File Size : 53,7 Mb
Release : 1983
Category : Electronic
ISBN : OCLC:786246996
Author : Sarah Adelman,Daniel Gilligan,Kim Lehrer
Publisher : Intl Food Policy Res Inst
Page : 85 pages
File Size : 46,6 Mb
Release : 2008
Category : Health & Fitness
ISBN : 9780896295094
Governments use food for education (FFE) programs to increase school participation and support learning through better nutrition. But how effective are these programs? This food policy review surveys the empirical literature to assess the impact of FFE programs on the students' schooling, learning, and nutrition. It examines the economic rationale for FFEs, critically assesses the evidence on their effectiveness, identifies areas where further research is needed, and offers guidelines for future program design and use.
Author : Jan Hoorweg,Rudio Niemeijer
Publisher : Routledge
Page : 155 pages
File Size : 50,9 Mb
Release : 2013-10-28
Category : Medical
ISBN : 9781136147227
First published in 1989. The studies that form the basis for this monograph were carried out between 1976 and 1979. The African Studies Centre in Leiden has a standing interest in child nutrition and provided the funds and resources for what was ambitiously termed the 'Nutrition Intervention Research Project'.
Author : Norman J. Temple,Nelia Patricia Steyn
Publisher : Unknown
Page : 493 pages
File Size : 45,6 Mb
Release : 2016
Category : Nutrition
ISBN : 1868887898
"Nutrition textbooks used by universities and colleges in developing countries have very often been written by scholars who live and work in North America or the United Kingdom. And while the research and information they present is sound, the nutrition-related health challenges with which developing countries must grapple differs considerably from those found in highly industrialized Western nations. The primary aim of Community Nutrition for Developing Countries is to address this issue. Written by both scholars and practitioners, the volume draws on their wealth of knowledge, experience, and understanding of nutrition in developing countries to provide nutrition professionals with the proper tools for the assessment and evaluation of nutritional status. Each chapter addresses a specific nutrition challenge currently faced by developing countries such as food security, food safety, disease prevention, maternal health, and effective nutrition policy. In addition, the volume serves as an invaluable resource for those developing and implementing nutrition education programmes. With an emphasis on nutritional education as a means to prevent disease and effectively manage health disorders, it is the hope of the nearly three dozen contributors to this work that it will enhance the health and wellbeing of low income populations throughout the world."--
Author : Harvard Institute for International Development,James E. Austin
Publisher : Unknown
Page : 248 pages
File Size : 48,9 Mb
Release : 1981
Category : Medical
ISBN : MINN:319510000217743
Abstract: A handbook on nutrition intervention to reach preschool children identifies major factors that professionals should consider in planning, designing, funding, operating, and evaluating nutrition programs in developing countries. Conceptual frameworks are presented for the intervention design and evaluation. These frameworkscover definition of the problem, design questions, and cost/effectiveness considerations. Design questions are specific to type of intervention. The 7 types of intervention programs examined are: supplementary feeding; nutrition education; fortification; formulated foods; consumer subsidies; agricultural production, and integrated programs (i.e. integrated with health care). Much data is presented in tabular form and a bibliography is included. (rkm).
Author : F L A M I N I O FIDANZA
Publisher : Springer
Page : 496 pages
File Size : 53,7 Mb
Release : 2013-11-22
Category : Medical
ISBN : 9781489969460
Author : Robert E. Klein
Publisher : Springer Science & Business Media
Page : 468 pages
File Size : 52,7 Mb
Release : 2012-12-06
Category : Science
ISBN : 9781468434897
As is noted in the opening chapter of this volume, nutrition and public health programs have been important throughout Latin America and the Caribbean for many years. This is due to the spe cial concerns of those responsible for setting national policies, the program experience and leadership in public health developed by the national governments, and the stimulus and cooperation of the Pan American Health Organization (PARO), including its twelve associated centers which focus on research, training and program development. The need for a coordinated hemisphere-wide attack on malnu trition and other health problems was expressed clearly in the "Ten Year Health Plan for the Americas" (1). This plan established specific targets for reducing the prevalence of the major nutri tional diseases and other health problems for the decade 1971-1980. It was noted at that time that very few countries had formulated adequate comprehensive national food and nutrition policies and plans, nor had they developed strategies for combating the nutri tional deficiencies known to affect large numbers of people through out the Region. Following a review of the available data on a country by country basis in 1975, the PARO Directing Council en dorsed recommendations for formulating the necessary national poli cies and strategies for the intersectorial execution of food, nutri tion and health programs (2). This report also summarized the available national data related to nutritional status, existing programs such as food fortification, and the human resources avail able for services as well as for research and education.
Author : Food and Agriculture Organization of the United Nations
Publisher : Food & Agriculture Org.
Page : 129 pages
File Size : 40,6 Mb
Release : 2019-03-05
Category : Medical
ISBN : 9789251312346
The School Nutrition Education Programme (SNEP) is an intervention to educate school students on nutrition and food preparation with the aim of influencing healthy nutrition choice and practice at an age when life time behaviour habits are developing and in the wider community. FAO defines School Food Nutrition Education as consisting of coherent educational strategies and learning activities, with environmental supports, which help schoolchildren and their communities to achieve sustainable improvements in their diets and in food- and lifestyle-related behaviours, perceptions, skills and knowledge; and to build the capacity to change, to adapt to external change and to act as agents of change. This publication is the scopy study and capacity needs assessment and final report for the SNEP project.
Author : National Library of Medicine (U.S.)
Publisher : Unknown
Page : 1028 pages
File Size : 53,9 Mb
Release : 2024-07-01
Category : Medicine
ISBN : STANFORD:36105214548989
Author : Jan Hoorweg
Publisher : Walter de Gruyter GmbH & Co KG
Page : 160 pages
File Size : 54,8 Mb
Release : 2019-07-08
Category : Language Arts & Disciplines
ISBN : 9783111416380
No detailed description available for "Evaluation of Nutrition Education in Africa".
Author : Geoffrey Howard Bourne
Publisher : Unknown
Page : 260 pages
File Size : 41,5 Mb
Release : 1987
Category : Diet
ISBN : UOM:39015010285677
Author : United States. Agency for International Development. Bureau for Technical Assistance
Publisher : Unknown
Page : 624 pages
File Size : 46,8 Mb
Release : 1976
Category : Agricultural assistance, American
ISBN : UIUC:30112018061181