Non-governmental organization facilitation of a community-based nutrition and health program: Effect on program exposure and associated infant feeding practices in rural India

September Non-governmental organization facilitation of a community-based nutrition and health program: Effect on program exposure and associated infant feeding practices in rural India Veena Singh 0 1 2 Saifuddin Ahmed 0 2 Michele L. Dreyfuss 0 2 Usha Kiran 0 2 Deepika N. Chaudhery 0 2 Vinod K. Srivastava 0 2 Ramesh C. Ahuja 0 2 Abdullah H. Baqui 0 2 Gary L. Darmstadt 0 2 Mathuram Santosham 0 2 Keith P. West 0 2 0 a Current address: Global Health Program, Bill and Melinda Gates Foundation , New Delhi, India ¤b Current address: Health , Nutrition and Population Global Practice, World Bank, New Delhi, India ¤c Current address: Hind Institute of Medical Sciences , Sitapur, Uttar Pradesh , India ¤d Current address: Department of Pediatrics, Stanford University , Stanford, California , United States of America work 1 Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland, United States of America, 2 Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland, United States of America , 3 CARE- India , New Delhi , India , 4 King George Medical University , Lucknow , India , 5 Health Systems Division, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , United States of America 2 Editor: Jacobus P. van Wouwe, TNO , NETHERLANDS Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The study was funded by USAID, India Mission, through Global Research Activity Award #HRN-A-00-96-90006-00 to the Johns Hopkins Bloomberg School of Public Health, MD, USA. VS was supported during analysis and reporting through Gates Grant GH 614 and the George G. Background Integrated nutrition and health programs seek to reduce undernutrition by educating child caregivers about infant feeding and care. Data on the quality of program implementation and consequent effects on infant feeding practices are limited. This study evaluated the effectiveness of enhancing a nutrition and health program on breastfeeding and complementary-feeding practices in rural India. Methods Utilizing a quasi-experimental design, one of the implementing districts of a Cooperative for Assistance and Relief Everywhere (CARE) nutrition and health program was randomly selected for enhanced services and compared with a district receiving the Government of India's standard nutrition and health package alone. A cohort of 942 mother-child dyads was longitudinally followed from birth to 18 months. In both districts, the evaluation focused on responses to services delivered by community-based nutrition and health care providers [anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)]. Graham Professorship Endowment at Johns Hopkins University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: UK and DNC managed the intervention but had no direct involvement in the evaluation. All other authors had no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Abbreviations: ANC, Antenatal checkups received; ANM, Auxiliary Nurse Midwives; AWC, Anganwadi center; AWW, Anganwadi Worker; BCC, Behavior change communication; BF, Breastfeeding; CARE, Cooperative for Assistance and Relief Everywhere; CBO, Community-based Organization; CF, Complementary-feeding; Comp, Comparison; GOI, Government of India; ICDS, Integrated Child Development Services; IFA, Iron-folic acid; INHP II, Integrated Nutrition and Health Program; Int, Intervention; JHBSPH, The Johns Hopkins Bloomberg School of Public Health (JHBSPH); KGMU, King George Medical University; LMP, Last Menstrual Period; NGO, Non-government Organization; PHC, Primary Health care center; RCH, Reproductive and Child Health; SF, Supplementary Food; SN, Supplementary Nutrition. Findings The CARE enhanced program district showed an improvement in program coverage indicators (e.g., contacts, advice) through outreach visits by both AWWs (28.8±59.8% vs. 0.7± 12.4%; all p<0.05) and ANMs (8.6±46.2% vs. 6.1±44.2%; <0.05 for ages 6 months). A significantly higher percentage of child caregivers reported being contacted by the AWWs in the CARE program district (20.5±45.6% vs. 0.3±21.6%; p<0.05 for all ages except at 6months). No differences in ANM household contacts were reported. Overall, coverage remained low in both areas. Less than a quarter of women received any infant feeding advice in the intervention district. Earlier and exclusive breastfeeding improved with increasing number or quality of visits by either level of health care provider (OR: 2.04±3.08, p = <0.001), after adjusting for potentially confounding factors. Socio-demographic indicators were the major determinants of exclusive breastfeeding up to (...truncated)