An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia

Objective: To determine which interventions can reduce linear growth retardation (stunting) in children aged 6-36 months over a 5-year period in a food-insecure population in Ethiopia. Design: We used data collected through an operations research project run by Save the Children UK: the Child Caring Practices (CCP) project. Eleven neighbouring villages were purposefully selected to receive one of four interventions: (i) health; (iii) nutrition education; (iii) water, sanitation and hygiene (WASH); or (iv) integrated comprising all interventions. A comparison group of three villages did not receive any interventions. Cross-sectional surveys were conducted at baseline (2004) and for impact evaluation (2009) using the same quantitative and qualitative tools. The primary outcome was stunted growth in children aged 6-36 months measured as height (or length)-for-age Z-scores (mean and prevalence). Secondary outcomes were knowledge of health seeking, infant and young child feeding and preventive practices. Setting: Amhara, Ethiopia. Subjects: Children aged 6-36 months. Results: The WASH intervention group was the only group to show a significant increase in mean height-for-age Z-score (+0.33, P = 0.02), with a 12.1% decrease in the prevalence of stunting, compared with the baseline group. This group also showed significant improvements in mothers' knowledge of causes of diarrhoea and hygiene practices. The other intervention groups saw non-significant impacts for childhood stunting but improvements in knowledge relating to specific intervention education messages given. Conclusions: The study suggests that an improvement in hygiene practices had a significant impact on stunting levels. However, there may be alternative explanations for this and further evidence is required.