Background and Objective
The endline survey was carried out for the evaluation of USAID/Bangladesh’s Improving Nutrition through Community-Based Approaches (INCA) project, which was designed to provide a comprehensive set of community and service strengthening activities with the objective of strengthening nutrition knowledge, practices,
and use of services to improve the nutritional status of pregnant women and children under age two (0–23 months) living in selected areas in southern Bangladesh. INCA was a three-year project (May 2017‒May 2020) with the specific objective to improve nutritional practices during the “first 1,000 days of life” to prevent irreversible stunting in children under the age of two. The project was implemented by Caritas Bangladesh and United Purpose. The INCA project was targeted to “1,000-day households” (households having pregnant women, lactating mothers, and children age two or younger) located in 11 hard-to-reach and disadvantaged coastal upazilas of the Bhola, Laxmipur, and Noakhali districts (an estimation suggests that there were about 3,004,228 people, including 106,420 pregnant women, and
100,407 live births, in 2015 in these upazilas). INCA used an array of interventions implemented mainly through a core of about 471 community nutrition promoters (CNPs). The CNPs counselled pregnant women and mothers of children under age two through sessions at the household, community, and facility levels. In addition, the project facilitated linking women and communities with health facilities (predominantly community clinics [CCs] and family welfare centers [FWCs]). INCA also built the nutrition skills of selected members from existing community clinic-based support groups (CCSGs) to act as nutrition focal points and to form community nutrition support groups (CNSGs).
The overall purpose of the INCA evaluation was to assess how well the project achieved those objectives, by examining changes in key population-level indicators of knowledge, practices, use of services, and nutritional status between the 2017 baseline and the 2019 endline surveys. Findings from this evaluation will serve three purposes: 1) to establish the impact of INCA interventions on a rural and undernourished area of the country; 2) to help USAID/Bangladesh design future nutrition interventions; and 3) to promote learning for other government or donor-funded projects that work in the field of nutrition. This evaluation also adds to the common evidence base of community-based interventions in low- and middle-income countries.
Procedures of Implementation
The evaluation consisted of baseline and endline surveys, conducted in September 2017–October 2017 and December 2019–January 2020, respectively, with mothers with children under two years and pregnant women in the project and comparison areas (eight upazilas bordering/neighboring the INCA areas). The evaluation was based on a prospective, quasi-experimental difference-in-differences (DID) design and used data from representative household surveys conducted in the 2017 baseline and 2019 endline. The endline survey was conducted on a representative sample of pregnant women and women with children under age two living in the INCA target areas and in the comparison areas. In total, 5,810 households were surveyed in INCA intervention areas and 5,271 households in comparison areas, along with 457 facilities and 272 out of 471 CNPs, in the endline survey—the sample size was selected to be sufficiently large to detect the expected changes in the key indicators, with 95% confidence and 80% power. Data were collected through face-to-face interviews to ensure confidentiality. Informed consent was obtained from participants prior to the interview, and ethical clearance for the study protocol and data collection instruments was obtained from the Bangladesh Medical Research Council and the University of North Carolina at Chapel Hill Institutional Review Board.
The major services are including development of sample methodology and drawing of sample; translation, pre-testing and finalization of questionnaires; training of field personal, conducting household listing and data collection by maintaining quality; data entry, processing, cleaning and submission of clean data sets to client; and assisting data analysis, tabulation and report writing. A total of 80,919 household were listed from randomly selected 260 clusters; collection of data through face-to-face interview from 17,419 households, 457 facilities including Health and Family Welfare Centers (UH&FWC), Community Clinic (CC), Smiling Sun NGO clinics; and Community Nutrition Providers.
The University of North Carolina at chaple Hill (UNC-CH), UNC- Chapel Hill/Carolina Population Center, 400 Meadowmont Village Circle, 3rd Floor Chapel Hill, NC 27517,USA and funded by USAID Phone (919) 962-6232.