Nutritional training in a humanitarian context: Evidence from a cluster randomized trial.

Behavioural change communication interventions have been shown to be effective at improving infant and young child nutrition knowledge and practices. However, evidence in humanitarian response contexts is scarce. Using data on secondary outcomes of breastfeeding, water treatment, and knowledge from a cluster randomized control trial of the Yemen Cash for Nutrition programme's impact on child nutritional status, this paper shows that the programme significantly improved knowledge and practices for poor women with young children in the pilot districts. The intervention consisted of cash transfers and monthly group nutrition education sessions led by locally recruited community health volunteers. Data are based on self-reports by participants. Estimating impacts among all 1,945 women in 190 clusters randomly assigned to treatment versus control and controlling for baseline levels and community characteristic and adjusting for noncompliance with randomization, the programme increased the probability of breastfeeding initiation within the first hour after delivery by 15.6% points (p < .05; control = 74.4% and treatment = 83.6%), the probability of exclusive breastfeeding during the first 6 months by 14.4% points (control = 13.5% and treatment = 25.3%), the probability of households treating water consumed by adults by 16.7% points (p < .01; control = 13.9% and treatment = 23.4%), and treating water consumed by children under two by 10.3% points (p < .10; control = 31.2% and treatment = 37.9%). Impacts on knowledge and breastfeeding are similar for both literate and illiterate women, and water treatment impacts are significantly larger for literate women. This study was registered at 3ie (RIDIE-STUDY-ID-5b4eff881b29a) and funded by the Nordic Trust Fund and Consultative Group on International Agricultural Research programme on Policies, Institutions, and Markets.

Ex post adjustment for measurement error in stunting calculations: an illustration from Egypt.

OBJECTIVE: The present study provides ranges for the magnitude of bias caused by measurement error in stunting rates, a widely used a proxy for long-term nutritional status. DESIGN: Stunting, which is determined by the number of cases that fall below -2 sd from the mean height-for-age in the population, mechanically increases with higher variance. This variance stems from both natural heterogeneity in the population and measurement error. To isolate the effect of measurement error, we model the true distributions which could give rise to the observed distributions after subtracting a simulated measurement error. SETTING: We analyse information from three rounds of the Demographic and Health Survey (DHS) in Egypt (2005, 2008 and 2014). Egypt ranks high among developing countries with low-quality anthropometric data collected in the DHS, currently the main source of anthropometry in the country. PARTICIPANTS: The study relies on re-analysis of existing DHS data, which record height, weight and age data for children under 5 years old. RESULTS: Under the most conservative assumptions about measurement error, the stunting rate falls by 4 percentage points for the most recent DHS round, while assuming higher levels of measurement error reduces the stunting rate more dramatically. CONCLUSIONS: Researchers should be aware of and adjust for data quality concerns in calculating stunting rates for cross-survey comparisons or in communicating to policy makers.