May 4, 2016 - 2.1 EVALUATION DESIGN. 24. 2.1.1 RATIONALE FOR AGE RANGE TO DETECT IMPACTS ON STUNTING. 25. 2.1.2 RANDOMIZ
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RAIN PROJECT: IMPACT EVALUATION REPORT An impact evaluation report prepared by the International Food Policy Research Institute of the Realigning Agriculture to Improve Nutrition (RAIN) project in Zambia
May 2016 Jody Harris, Phuong Hong Nguyen, John Maluccio, Adam Rosenberg, Lan Tran Mai, Wahid Quabili, Rahul Rawat
Acknowledgements
A large community-based study like this could not be completed without the coordinated efforts of many people. The International Food Policy Research Institute (IFPRI) team thanks all those who facilitated every step of this process:
Concern Worldwide staff in Dublin, particularly the Strategy Advocacy and Learning (SAL) advisors and the Zambia liaisons within the International Programmes Department, for their support and commitment to the RAIN project and its evaluation.
Concern Worldwide staff in Zambia for their constant support for our work. In particular, Gudrun Stallkamp who provided critical overall support to this evaluation, and who provided inputs in selecting sites for the evaluation, commented on several pieces of this survey including the evaluation design, ethics approval application, questionnaire revisions, and for connecting the evaluation team with other key personnel at Concern Worldwide; this survey could not have been completed with her support
Mumbwa Child Development Agency (MCDA) for their support in implementing the project
Palm Associates for facilitation of administrative and logistical support to the survey fieldwork.
The Government of Zambia health and agriculture officials in Mumbwa District and Central Province who provided support to this survey and to the RAIN project
The National Food and Nutrition Commission for loaning the survey team anthropometric equipment, and for invaluable support to anthropometric training of enumerators
The entire survey team from Palm Associates from both survey rounds, including the research assistants, field supervisors, fieldworkers, and data entry and management team
Finally, to the women and children that belong to the households who participated in the surveys, we thank you for your role in making this a success. Your contributions of time and information, and your dreams for a more healthy future for your children are at the very heart of this project.
The RAIN project was funded by Irish Aid and the Kerry Group with additional support from the Bank of Ireland. Funding for the evaluation was provided by Concern Worldwide, through grants received from Irish Aid, Kerry Group, and PATH through support provided by the UK Government’s Department for International Development. Additional support for the evaluation was provided by the CGIAR research program on Agriculture for Nutrition and Health, led by IFPRI. The views expressed herein are those of the authors and in no way can be taken to reflect the official opinions of the funding organisations.
Acronyms BMI
Body Mass Index
CSA
Census Supervisory Area
CSO
Central Statistics Office
CWW
Concern Worldwide
DHS
Demographic and Health Survey
DPT
Diphtheria/Polio/Tetanus
ENA
Essential Nutrition Actions
FANTA
Food and Nutrition Technical Assistance
HAZ
Height-for-age z-score
HDDS
Household Dietary Diversity Score
HHS
Household Hunger Scale
IFPRI
International Food Policy Research Institute
IYCF
Infant and Young Child Feeding
NFNC
National Food and Nutrition Commission
NGO
Non-governmental Organization
OPV
Oral Polio vaccine
RAIN
Realigning Agriculture to Improve Nutrition
SEA
Supervisory Enumeration Area
WAZ
Weight-for-age z-score
WHO
World Health Organization
WHZ
Weight-for-height z-score
Table of contents EXECUTIVE SUMMARY
IX
1 INTRODUCTION
20
1.1 1.2 1.3 1.4
20 21 22 23
OVERVIEW OF THE NUTRITION SITUATION IN ZAMBIA DESCRIPTION OF THE RAIN PROJECT EVALUATION OBJECTIVES STRUCTURE OF THE REPORT
2 METHODS
24
2.1 EVALUATION DESIGN 2.1.1 RATIONALE FOR AGE RANGE TO DETECT IMPACTS ON STUNTING 2.1.2 RANDOMIZATION PROCESS 2.1.3 SAMPLE SIZE ESTIMATE 2.1.4 SAMPLING METHODOLOGY 2.2 SURVEY INSTRUMENTS 2.2.1 CONCEPTUAL BASIS FOR THE IMPACT EVALUATION QUESTIONNAIRE 2.2.2 HOUSEHOLD QUESTIONNAIRE 2.2.3 ANTHROPOMETRIC MEASUREMENT 2.3 DATA COLLECTION AND MANAGEMENT 2.3.1 TRAINING OF PERSONNEL 2.3.2 SURVEY TEAM COMPOSITION 2.3.3 DATA MANAGEMENT 2.3.4 SURVEY INFORMATION 2.4 DATA ANALYSIS 2.4.1 EXPOSURE TO THE PROGRAM 2.4.2 IMPACT ESTIMATES ON MAIN AND SECONDARY OUTCOMES 2.4.3 DECOMPOSITION ANALYSIS 2.5 ETHICAL APPROVAL
24 25 26 27 28 29 29 30 30 31 31 32 32 33 33 36 36 37 37
3 RESULTS: BASELINE CHARACTERISTICS
39
3.1 KEY BASELINE INDICATORS
39
4 RESULTS: RAIN INTERVENTION EXPOSURE
41
4.1 KEY PROGRAM EXPOSURE INDICATORS 4.2 COMMUNITY EXPOSURE TO NON-RAIN PROGRAMS
41 45
5 RESULTS: IMPACT OF RAIN INTERVENTIONS ON ANTHROPOMETRIC OUTCOMES
47
5.1 MAIN IMPACT ANALYSIS OF RAIN INTERVENTIONS ON ANTHROPOMETRIC OUTCOMES 47 5.1.1 INTENT-TO-TREAT OUTCOMES FOR ANTHROPOMETRIC OUTCOMES AMONG CHILDREN 24-59.9 MONTHS OF AGE 48 5.1.2 INTENT-TO-TREAT OUTCOMES FOR ANTHROPOMETRIC OUTCOMES AMONG CHILDREN 6-23.9 MONTHS OF AGE 50 5.2 PLAUSIBILITY ANALYSIS 1: HIGH POTENTIAL FOR EXPOSURE AGE GROUPS (24-47.9 MONTHS) 52 5.3 PLAUSIBILITY ANALYSIS 2: DOSE-RESPONSE RELATIONSHIP BETWEEN PROGRAM EXPOSURE CHILD NUTRITION 56 5.4 PLAUSIBILITY ANALYSIS 3: CHANGES IN THE UNDERLYING DETERMINANTS OF CHILD GROWTH AND NUTRITION 60 5.4.1 CHILD CHARACTERISTICS 60 5.4.2 MATERNAL CHARACTERISTICS: DEMOGRAPHIC, HEALTH SEEKING BEHAVIOR, AND NUTRITIONAL STATUS 64 5.4.3 HOUSEHOLD CHARACTERISTICS: FOOD SECURITY, DIETARY DIVERSITY, SOCIOECONOMIC STATUS, AND ACCESS TO SERVICES 72 6 RESULTS: IMPACT OF RAIN INTERVENTIONS ON IYCF PRACTICES
79
6.1 MAIN IMPACT ANALYSIS OF RAIN INTERVENTIONS ON IYCF OUTCOMES 79 6.2 PLAUSIBILITY ANALYSIS: DOSE-RESPONSE RELATIONSHIP BETWEEN PROGRAM EXPOSURES AND IYCF PRACTICES 86 7 RESULTS: IMPACT OF RAIN INTERVENTIONS ON KNOWLEDGE AMONG CAREGIVERS
89
7.1 IMPACT RAIN PACKAGE OF INTERVENTION ON NUTRITION AND HYGIENE KNOWLEDGE
89
8 RESULTS: IMPACTS OF RAIN INTERVENTIONS ON THE WOMEN’S EMPOWERMENT
96
8.1 WOMEN’S SOCIAL EMPOWERMENT 8.2 WOMEN’S ECONOMIC EMPOWERMENT 8.3 WOMEN’S EMPOWERMENT IN AGRICULTURE AT ENDLINE
97 102 107
9 RESULTS: IMPACT OF RAIN INTERVENTIONS ON PRODUCTION OF NUTRIENT-RICH FOODS
110
9.1 FOOD PRODUCTION
110
10 RESULTS: DECOMPOSITION ANALYSIS OF THE DETERMINANTS OF CHANGES IN CHILD GROWTH OUTCOMES OVER TIME 118 10.1 DETERMINANTS OF CHILD GROWTH
118
11 DISCUSSION
134
REFERENCES
139
12 APPENDICES
140
APPENDIX 1: DETAILED SAMPLE SIZE CALCULATIONS APPENDIX 2: VARIABLES INCLUDED IN THE DECOMPOSITION ANALYSIS APPENDIX 3: DETAIL ON THE RAIN PROJECT APPENDIX 4: COMPARING RAIN AND DHS APPENDIX 5: EXPLAINING THE IMPACT OF RAIN: PROGRAM IMPACT PATHWAYS
140 145 147 150 151
List of tables TABLE 2.1.1. SAMPLE SIZES ................................................................................................................................................28 TABLE 2.1.1. SAMPLE SIZES USED FOR ANALYSES ....................................................................................................................34 TABLE 2.4.1: ANALYSIS METHODS- USE AND INTERPRETATION ..................................................................................................35 TABLE 3.1.1 BASELINE CORE IMPACT INDICATORS BY PROGRAM GROUP ......................................................................................39 TABLE 3.1.2. SELECTED BASELINE MATERNAL UNDERLYING FACTORS BY PROGRAM GROUP ..............................................................40 TABLE 3.1.3. SELECTED BASELINE HOUSEHOLD UNDERLYING FACTORS BY PROGRAM GROUP ............................................................40 TABLE 4.1.1 PROGRAM EXPOSURE: PARTICIPATION AND DELIVERY .............................................................................................42 TABLE 4.1.2 PROGRAM PARTICIPATION ...............................................................................................................................43 TABLE 4.1.3. PROGRAM PARTICIPATION (AMONG MOTHERS WITH CHILDREN
