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Assessment of an adolescent-girl-focused nutritional educational intervention within a girls’ empowerment programme: a cluster randomised evaluation in Zambia

Published online by Cambridge University Press:  22 July 2020

Paul C Hewett
Affiliation:
Population Council, Washington, DC, USA
Amanda L Willig
Affiliation:
Deptarment of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
Jean Digitale
Affiliation:
Population Council, New York, NY, USA Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
Erica Soler-Hampejsek
Affiliation:
Population Council, New York, NY, USA Independent consultant, Barcelona, Spain
Jere R Behrman
Affiliation:
Department of Economics, University of Pennsylvania, Philadelphia, PA, USA Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
Karen Austrian
Affiliation:
Population Council, Nairobi, Kenya
Corresponding
E-mail address:

Abstract

Objective:

Adolescent girls are at risk for both macro- and micronutrient deficiencies affecting growth, maternal and child health. This study assessed the impact of an adolescent-girl-tailored nutritional education curriculum on nutritional outcomes, including knowledge, dietary behaviour, anthropometry and anaemia.

Design:

A cluster-randomised evaluation was conducted with two study arms: girls in mentor-led weekly girls’ groups receiving sexual and reproductive health and life-skills training assigned to an age-appropriate nutritional curriculum and control girls in the weekly girls’ groups without the nutritional education. The primary analysis was intent-to-treat (ITT) generalised least squares regression. Secondary analysis using two-stage, instrumental-variables estimation was also conducted.

Setting:

The intervention and evaluation were conducted in urban and rural areas across four of ten provinces in Zambia.

Participants:

In total, 2660 girl adolescents aged 10–19 years were interviewed in 2013 (baseline) and annually through 2017.

Results:

ITT results indicate that exposure to the nutritional educational programme did not meaningfully change outcomes for adolescents or their children. Intervention adolescents were no more likely to correctly identify healthy foods (P = 0·51) or proper infant-feeding practices (P = 0·92); were no less likely to be stunted (P = 0·30) or underweight (P = 0·87) and no less likely to be anaemic (P = 0·38). Outcomes for children of intervention participants were not improved, including being breastfed (P = 0·42), stunted (P = 0·21), wasted (P = 0·77) or anaemic (P = 0·51).

Conclusions:

Even a high-quality nutritional educational intervention tailored to adolescents within an empowerment programme does not assure improved nutritional outcomes; adolescent preferences, resource control and household dynamics require consideration in the context of nutritional educational programmes.

Type
Research paper
Copyright
© The Authors 2020

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References

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