Objectives
To determine whether integrating access to OFSP into public health services for pregnant women results in improved ante-natal clinic (ANC) service utilization, nutritional and caregiving knowledge, frequency of vitamin A intakes and nutritional status among their children.
Methods
Repeat cross-sectional surveys among 1989 mother-child (6-24 months) pairs at baseline (March-May 2011) and 2271 mother-child pairs at endline (March-May 2014) to examine impact of the Mama SASHA intervention for pairs living in catchment areas of four facilities offering the intervention package compared to four control areas. The 32 month intervention linked access to OFSP planting material to receiving nutritional counseling at ANC clinics and encouraged monthly attendance at pregnant women’s clubs. A rapid enzyme immunoassay technique was used to assess retinol-binding protein (RBP) as an indicator of vitamin A in children.
Results
At endline, women fully participating (redeemed vouchers for OFSP; attended clubs) and those partially participating had significantly higher levels of ANC attendance, knowledge, diet diversity, and frequency of vitamin A intakes than those in control areas. Difference-in-difference estimates between endline and baseline values were significantly higher for these indicators in intervention than in control areas. For biological indicators, propensity score matching was used to eliminate selection bias between children of full participants at endline with control children. A 7% reduction in stunting (p-value=0.086) and 8% reduction (p-value=0.035) in vitamin A deficiency (RBP<0.825 µmol/L) among apparently healthy children (C-reactive protein<5 mg/L) was found for full participant children only.
Conclusions
Full participation in the intervention was critical for achieving impact on nutritional status.
