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Assessing the Effectiveness of an Integrated, Community-Based Child Health and Nutrition Program: The Atención Integral a la Niñez (AIN) Program in Honduras

Presenter: Karen Van Roekel (BASICS)

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AIN Experience: Karen Van Roekel (BASICS)

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Overview: This presentation focuses on the results of the midterm evaluation conducted by the BASICS II Project under funding from USAID. This evaluation was designed to assess the effectiveness of the community-based AIN program in promoting the growth of children under two years of age through integrated health and nutrition activities.

Methodology: Presented data compares the results of a midterm household survey conducted in 2000 with the baseline in 1998.

Background data on households, caretakers and postpartum care will be presented as well as findings on a number of important program areas such as vaccinations, growth and development, diarrhea, acute respiratory infections, breastfeeding and complimentary feeding. The results of this evaluation serve to document changes that have taken place since the time of the baseline survey in AIN caretakers' knowledge, attitudes, and practices in comparison to trends in control communities. BASICS is also planning a third household survey for June 2002 to evaluate the contribution of the program to reducing the prevalence of malnutrition and the severity and duration of diarrhea and ARI in children under two.

Results: Results of the midterm evaluation show that 92% of the caretakers of children under two participate in the AIN program in their community. Compared to control communities, these caretakers are significantly more likely to provide oral rehydration therapy to children with diarrhea and to exclusively breastfeed children for the first six months of life.

Children 12-23 months of age in AIN communities are significantly more likely to have received their vaccinations for DPT, polio and measles (but not BCG) than children in control communities.

AIN caretakers are also significantly more likely to know danger signs for diarrhea and respiratory infections than caretakers in control communities.

AIN caretakers scored significantly higher than controls on the composite knowledge and attitudes score for nine variables related to child feeding.

Program and Policy implications: The midterm survey results show that an integrated community-based program such as AIN, which is being scaled up as the national nutrition policy of the Ministry of Health of Honduras, can positively impact the behavior of caretakers of children under two. The midterm results also indicate some aspects of the program which should be strengthened including encouraging the early enrollment of children through home visits to newborns, increasing coverage with BCG, strengthening the intensity of participation in monthly weighing sessions toward the goal of 100% of children participating each month, and increasing the use of counseling cards for more effective negotiations on improved practices with caretakers.

Further reading: The BASICS II Project has prepared a report entitled "BASICS II Midterm Evaluation of the AIN Program in Honduras, 2000". Once the technical review is complete, this report will be disseminated on the BASICS website at www.basics.org.

Karen Van Roekel is an Associate Technical Officer in the Performance and Results Monitoring unit of the BASICS II Project. She is responsible for designing and managing a variety of monitoring and evaluation activities in seven country programs including integrating performance measures into workplans, analyzing data on results achieved, and documenting findings. Prior to joining BASICS in 2000, Ms. Van Roekel served as a Program Officer in the Partnerships for Health Reform (PHR) Project, as a Program Manager on the Opportunities for Micronutrient Interventions (OMNI) Project, and as the Data Management Coordinator for the Georgia Migrant Health Program. Her international experience includes three years of service as a Peace Corps Volunteer in Morocco and Senegal. Ms. Van Roekel holds an MPH, an MA in Linguistics, and a BA in Anthropology and Spanish.