(P28-007-24) Effectiveness of Intervention Package of Specialized Nutritious Foods and BBC During the First 1,000 Days of Life to Prevent Stunting Among Children in Afghanistan

Objectives: This project aimed to assess the effectiveness of specialized nutritious food (SNF),social and behavior change communication (SBCC) intervention to prevent stunting among children under 2 years during the first 1,000 days of life in Badakhshan, Afghanistan.

Methods: We used a quasi-experimental pre-post study design with a control group. Pregnant and lactating women received a monthly ration of 7.5 kg of Super Cereal (250g/day) during pregnancy and the first 6 months of lactation. Children aged 6-23 months received 30 sachets of medium-quantity lipid-based nutrient supplement (50g/sachet/day) monthly. We compared pre- and post-intervention assessments of the intervention and control groups to isolate the effect of the intervention on key study outcomes at the endline by difference-in-differences (DID) estimates. This study is registered on Clinicaltrials.gov, number NCT04581993.

Results: A total of 2,928 and 3,205 households were surveyed at baseline and endline. DID estimates adjusted for child, maternal, and household characteristics indicated a significant reduction in stunting (DID: -5%; p=0.041) and underweight (DID: -4.6%; p=0.028) among children < 2 years of age. However, DID estimates for wasting among children in the intervention and control groups were not significantly different (DID: -1.7; p=0.315). Additional analyses suggest that exposure to the SBCC messages was associated with improvements in multiple IYCF practices, including early initiation of breastfeeding (DID: 19.6%, p< 0.001), exclusive breastfeeding for children under 6 months (DID: 11.0%, p=0.014), minimum meal frequency (DID: 23%, p< 0.001), minimal acceptable diet (DID: 13%, p< 0.001), and whether a child was ever breastfed (DID: 4.7%, p< 0.001).

Conclusions: The provision of SNF in combination with SBCC during the first 1,000 days of life was associated with reduction in stunting and underweight and improvements in IYCF practices among children under 2 years of age. Findings from this study have important implications for policy development and intervention programmes to combat undernutrition during the first 1,000 days of life in resource-limited countries.

Funding Sources: World Food Programme, Afghanistan