Impact of a UNICEF child survival strategy on the nutritional status of children under three in Rajasthan, India

Background: The Indian state of Rajasthan is characterized by high levels of child malnutrition as a result of poor caring and feeding practices. UNICEF India designed Anchal Se Angan Tak (ASAT) as on overlay to the national Integrated Child Development Services (ICDS) program to help improve nutritional status and child survival. This study evaluated the effectiveness of ASAT in significantly improving the nutritional status of children under three. Methods: A multistage random sampling study design was used. Questionnaires were administered to female primary caregivers and child anthropometric measurements were taken in two comparable districts (one receiving ASAT services; one not receiving ASAT services). Total sample size was 1403 child/caregiver pairs. Z-scores were calculated using both the 2000 CDC NCHS growth reference and the 2004 WHO growth reference standards. Results: Rates of colostrum feeding (47.1% ASAT, 34.4% non-ASAT; p<0.01) and mean HAZ scores were significantly better in ASAT areas (-1.63 ASAT, -1.92 non-ASAT; p<0.01). A trend of worsening z-scores, though, was found amongst males and females as age increased. Regression analysis demonstrated the importance of proper complementary feeding and the positive effect of ASAT (p<0.05) in improving the nutritional status of children under three. Conclusions: Results highlight the important role of behavior change strategies in improving the nutritional status of children under the age of three. Application/Significance: Based on the results of this study, program managers will be able to tailor current and future strategies to achieve maximal impact in improving the nutritional status of this vulnerable age group.