1) A community nutrition and asset transfer program in Bangladesh adapted its implementation during COVID-19, delivering activities through smaller individual and group meetings instead of larger gatherings. 2) Short-term program outcomes like weight gain and underweight rates among children were maintained during the pandemic compared to previous years. 3) Asset transfer effectively supported economic development participants, with most households sustaining or producing assets like chickens and home gardens over 18 months, including during the pandemic.

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
December 2, 2021
Yunhee Kang, PhD, Johns Hopkins School of Public Health
Heeyeon Kim, PhD, independent consultant
Eunsuk Lee, PhD, Korea Institute for International Economic Policy
Md.Iqbal Hossain, World Vision Bangladesh
Jaganmay Prajesh Biswas, World Vision Bangladesh
Julie Ruel-Bergeron, PhD, World Bank
Yoonho Cho, World Vision Korea
Adaptive implementation of a
community nutrition and
asset transfer program
during COVID-19 pandemic in
rural Bangladesh

2. • Scaled-down health and nutrition services due to COVID-19 measures threaten
the wellbeing of children.
• Bangladesh Rajshahi Division Maternal and Child Nutrition (BRDMCN):
A community-based program involving social behavior change communication
(SBCC) and economic development (ED) of asset transfer for income generation
was implemented by World Vision Bangladesh from Mar 2018-Dec 2020 (Kang et
al.)
• This study aimed to describe how the implementation modality was adapted and
the short/intermediate program outcomes changed during the pandemic (2020)
compared to the pre-pandemic (2018-2019)
Rationale/objective

3. Conceptual framework of evaluation components

4. 1) Population Year Comparison
community
Intervention
community
Program
impact (pp)
P
Underweight, % 2018 22.8 32.1 2.0 pp 0.45
2020 23.7 31.0
2) Cohort Year PD Hearth group PD Hearth/ED group Program
impact (pp)
P
Underweight, % 2018 83.6 92.8 -2.6 pp 0.42
2019 18.6 24.7 3.4 pp 0.39
2020 47.7 56.2
Program impact at population level and among
a cohort group

5. Methods/analysis
Reviews of annual progress/evaluation reports
• The percentage of the number of activities delivered compared to the expected number of
activities
Cohort survey
• A cohort group (n=1094) was assessed in 2020 for the perceived influence of COVID-19
• PD/Hearth vs. PD/Hearth+ED program participants
Monitoring records for PD/Hearth and ED programs (2019-2020)
• The percentage of sustained production activity of 2,960 ED households
• Changes in % weight gain (>200g) and % underweight among 11984 children

6. 0% 20% 40% 60% 80% 100% 120% 140% 160%
No. of sessions
No. of participants
No. of sessions
No. of participants
No. of sessions
No. of participants
No. of ED monthly meeting
No of ED trainings (best practice visit)
No. of CF meetings with ED groups
No. of sessions
No. of participants
No. of sessions
No. of participants
No. of CF/CS monthly meetings
No. of CG/CSG orientation meetings
PD/Heart
h
Commun
ity
nutrition
educatio
n
GMP
Economic
Development
Program
Capacity
building
via
school
campaig
n
WATSAN
training
CF/CS
meeting
% Delivered/Targeted activities
Y 2018 Y 2019 Y 2020
PD/Hearth
Community nutrition
education
GMP
Economic
development
program
Capacity building via
school campaign
WASH trainings
CF/CS meetings
*

7. Influence of COVID-19 on managing asset
during covid-19 among economic
development (ED) participants in 2020
(n=469)
Perceived changes in using community health facilities
during COVID-19 (n=998)

8. Before COVID-19 During COVID-19
Year 1 Year 2 Year 3
(n=5,265) (n=4,830) (n=1,889)
Weight Gain (≥200g) after 12-days enrollment 72.1% 64.8% 69.0%
Weight gain (≥400g) after 30-days enrollment 62.6% 64.6% 69.7%
Underweight (Weight-for-age z score<-2)
At enrollment 75.7% 74.8% 69.3%
In 12 days 62.3% 66.4% 60.6%
Percentage point (pp) diff. 13.4 pp 8.4 pp 8.7 pp
In 30 days 55.4% 58.0% 52.8%
Percentage point (pp) diff. 20.3 pp 16.8 pp 16.5 pp
Weight gain and underweight status at enrollment, 12
and 30 days of enrollment among PD/Hearth children

9. % Households having or producing assets
over 18 months follow-up
p=0.10
p<0.001
p=0.12
p<0.001
p=0.34
0
20
40
60
80
100
Received ducks
(n=2095)
Not receive ducks
(n=865)
Received chickens
(n=872)
Not receive chickens
(n=2088)
Received home
gardening (n=2403)
%
JAN-MAR 2019 APR-JUN 2019 JUL-SEP 2019 OCT-DEC 2019 APR-JUN 2020

10. • Delivery modes or frequency of activities were adapted under mobility restrictions:
One-to-one home visits or small group meetings, instead of group education or large
group gathering.
• Adaptive management may influence program reach, fidelity, and expected long-term
impacts.
• Asset transfer for income generation/food production can be an effective protection
program for poor families to get through the economic crisis.
Policy implications

11. Thank you!