Social Franchising and a Nationwide Mass Media Campaign Increased the Prevalence of Adequate Complementary Feeding in Vietnam: A Cluster-Randomized Program Evaluation1,2,3
- Rahul Rawat4,
- Phuong Hong Nguyen4,*,
- Lan Mai Tran5,
- Nemat Hajeebhoy5,
- Huan Van Nguyen6,
- Jean Baker5,
- Edward A Frongillo7,
- Marie T Ruel4, and
- Purnima Menon4
- 4Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC;
- 5Alive & Thrive, FHI 360, Washington, DC;
- 6Save the Children, Hanoi, Vietnam; and
- 7University of South Carolina, Columbia, SC
- ↵*To whom correspondence should be addressed. E-mail: p.h.nguyen{at}cgiar.org.
Abstract
Background: Rigorous evaluations of health system–based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM).
Objective: We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators.
Methods: A cluster-randomized, nonblinded evaluation design with cross-sectional surveys (n = ∼500 children aged 6–23.9 mo and ∼1000 children aged 24–59.9 mo/group) implemented at baseline (2010) and endline (2014) was used. Difference-in-difference estimates (DDEs) of impact were calculated for intent-to-treat (ITT) analyses and modified per-protocol analyses (MPAs; mothers who attended the social franchising at least once: 62%).
Results: Groups were similar at baseline. In ITT analyses, there were no significant differences between groups in changes in CF practices over time. In the MPAs, greater improvements in the intensive than in the nonintensive group were seen for minimum dietary diversity [DDE: 6.4 percentage points (pps); P < 0.05] and minimum acceptable diet (8.0 pps; P < 0.05). Significant stunting declines occurred in both intensive (7.1 pps) and nonintensive (5.4 pps) groups among children aged 24–59.9 mo, with no differential decline.
Conclusions: When combined with MM and CM, an at-scale social franchising approach to improve IPC, delivered through the existing health care system, significantly improved CF practices, but not child growth, among mothers who used counseling services at least once. A greater impact may be achieved with strategies designed to increase service utilization. This trial was registered at clinicaltrials.gov as NCT01676623.
- complementary feeding
- interpersonal counseling
- mass media
- child undernutrition
- cluster-randomized trial
- effectiveness evaluation
- Vietnam
Footnotes
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↵1 Support for this evaluation and the implementation of the interventions was provided by the Bill & Melinda Gates Foundation, through Alive & Thrive (A&T), managed by FHI 360; additional financial support to the evaluation study was provided by CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI). The Gates Foundation and A&T participated in the study design choices; neither participated in the data collection or analysis. A&T provided specific written inputs to the manuscript on intervention design and scale and provided feedback on the interpretation of the results. A&T and the Gates Foundation gave extensive feedback at all stages of the project, but freedom to publish the study findings was protected contractually in the agreement between the respective funding sources and IFPRI. All final decisions on the manuscript were made by the researchers. This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).
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↵2 Author disclosures: R Rawat, PH Nguyen, LM Tran, EA Frongillo, MT Ruel, and P Menon, no conflicts of interest. N Hajeebhoy, HV Nguyen, and J Baker were members of the program implementation team that designed and implemented the interventions studied and reported on in this article. They reviewed the manuscript and provided contextual interpretation of the results, but final decisions for manuscript content lay with the primary authors from the evaluation team (PH Nguyen, LM Tran, EA Frongillo, MT Ruel, R Rawat, and P Menon).
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↵3 Supplemental Tables 1–4 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.
- Manuscript received: November 7, 2016.
- Initial review completed: December 13, 2016.
- Revision accepted: January 13, 2017.
This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).
