Has the first implementation phase of the Community Nutrition Project in urban Senegal had an impact?
Agnès Gartner1, Yves Kameli, Pierre Traissac
1Institute de Recherche pour le Développement (IRD), UR 106, Nutrition Unit (WHO Collaborating Centre for Nutrition), Montpellier, France. gartner@mpl.ird.fr
Insights
The Community Nutrition Project (CNP) in Senegal showed no significant impact on child malnutrition due to external factors and population mobility. Improvements were observed in both intervention and control zones, indicating the need for robust study designs.
Area of Science:
- Public Health Nutrition
- International Development
- Child Health Interventions
Background:
- Child malnutrition remains a significant public health challenge in low-income urban settings.
- The Community Nutrition Project (CNP) aimed to address malnutrition in Senegal through targeted interventions.
- Assessing the effectiveness of such projects requires rigorous evaluation methodologies.
Purpose of the Study:
- To evaluate the impact of the Community Nutrition Project (CNP) in Senegal on child malnutrition.
- To determine if CNP interventions led to measurable improvements in underweight, wasting, and stunting.
- To assess the effectiveness of growth monitoring, food supplementation, and maternal education.
Main Methods:
- A quasi-experimental design comparing intervention zones (IZ) and control zones (CZ) was employed.
- Data collected before and after the 6-month intervention period included anthropometric measurements of children aged 6-35 months.
- Impact was assessed by analyzing changes in underweight, wasting, and stunting rates using -2 or -3 z-score thresholds.
Main Results:
- While the decrease in wasting was statistically significant in the control zone, the intervention zone showed a less pronounced reduction.
- No significant difference in stunting changes was observed between the intervention and control zones.
- Severe wasting, stunting, and underweight were eliminated in infants aged 6-11 months within the intervention zone.
Conclusions:
- The study failed to demonstrate a significant impact of the CNP due to similar or greater improvements observed in the control zone.
- Factors such as population mobility and potential weaknesses in project implementation may have confounded the results.
- The findings underscore the importance of quasi-experimental designs and careful consideration of contextual factors in evaluating nutrition interventions.
Objective:
We evaluated the impact of the Community Nutrition Project (CNP) of Senegal, West Africa on the population. In poor urban districts, the CNP provided underweight 6- to 35-mo-old children with growth monitoring/promotion and food supplementation, and education for mothers for a period of 6 mo.
Methods:
A before/after intervention and intervention zone (IZ)/control zone (CZ) design was used to assess whether CNP had an impact 18 mo after it began in Diourbel. Exhaustive samples included children 6-35 mo old in the CZ (n = 895 before and 917 after) and IZ (n = 912 and 759). The impact was assessed by the differential effect of the zone on changes in underweight, wasting, and stunting defined by the threshold of -2 or -3 z scores.
Results:
The decrease in wasting was higher in the CZ (from 13.7% to 8.6% versus 11.3% to 10.8%, P = 0.042). Changes in stunting did not differ between zones (18.8% to 14.5% versus 15.1% to 14.7%, P = 0.21). However, in the IZ, severe wasting, stunting, and underweight disappeared in children 6-11 mo of age. In the CZ, the socioeconomic data and some outcomes in children reflected a favorable context independent of the CNP.
Conclusion:
Despite a globally satisfactory decrease in malnutrition in the IZ, no impact was demonstrated because the same or an even larger decrease was observed in the CZ, highlighting the importance of relying on a quasi-experimental design. This may be explained in part by weaknesses in the process, which probably interfered with a potential impact, and by the high degree of population mobility, which could have interfered with efficiency assessed on a geographic scale.
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