Finding the holy grail to tackle stunting in young children

To measure our impact in tackling stunting, a serious growth deficit in children, we organise community sessions to monitor child growth. In 2017, we tracked the development of over 7,000 children in both urban slums and rural villages. What we didn’t expect is how powerful these sessions proved to be in triggering behaviour change…

(Article by Ania Sharwood - photo header by Wouter van Gens)

A few years ago, after evaluating our 4-year programme Max WASH, we decided to focus more on stunting, a serious growth deficit in children (see box at bottom of article for more info). With this adapted focus, Max Foundation moved from just working on preventing diarrhea and other waterborne diseases, to making sure children achieve full health in their early years. 

How do you change people’s ways?

To change people’s habits, especially when they are culturally embedded, is not easy. Even when the need is urgent. Think how difficult it is to get people to live more sustainably in the West, despite warnings about climate change. When Max Foundations starts working in remote communities in Bangladesh and Nepal, parents have no idea that their children are too small, let alone that bad hygiene is causing it (see box above). So, educating people about this is crucial. But as many development organisations will attest to, it remains a challenge to get people to change their habits, and stick to the new ones. 

The success of ‘outdoor baby clinics’

Our monitoring sessions are organised in communal spaces in both rural villages and urban slums. Mothers and other caregivers are invited to join every month so that local health workers can measure and weigh their babies. The results are compared to a ‘healthy growth’ chart (see photo below), much like in the baby clinics we know in the West. People see with their own eyes when their child is below the national average, as well as the difference between children in the community.

(Photo by Wouter van Gens - courtyard session for growth monitoring)

During the meetings, mothers exchange experiences and learn from each other. Together they identify ‘risky behaviours’ with regard to hygiene. The health workers further help to advise on aspects such as handwashing, preparing food hygienically, breastfeeding practices and proper sanitation hardware. Max Foundation works with local entrepreneurs to make sure people have access to decent quality sanitation hardware - latrines and washing basins - at an affordable price.

After making these changes, mothers return to the next monitoring session with their children. Over time The positive difference in their children’s development becomes clear to them. This appears to motivate them to change and/or maintain their changes. Project staff are seeing more and more willingness within the community to adept hygiene behaviour and co-invest in new latrines and washing basins.

(Photo by Carel de Groot - growth monitoring session)

Is there enough proof of effectiveness?

Last year we implemented growth monitoring in the majority of our programmes in Bangladesh; with communities in around 62 unions (a union has up to nine villages). In 2017 we monitored over 7,000 children on a regular basis. The preliminary results of these activities are encouraging: in our project area Kalkini, Madaripur for example, severe stunting of small children was reduced from 30% to 5% within two years. We were expecting improvements, but not to see such drastic declines.

Lasting behaviour change is in our view the ‘holy grail’ to have a true impact in child health. Growth monitoring sessions are looking like a powerful method to achieve this, and in our view worth the investment in working closely with the communities.

Even though other organisations and governments do growth monitoring, as far as we know they're not yet used as a trigger to change hygiene behaviour. As there is also some discussion on whether the impact is significant enough, it’s important for us to get sufficient evidence. This year, project staff in Bangladesh and Nepal will be collecting more data and verifying all our results. Hopefully, if indeed proven to be effective, others too will mainstream growth monitoring in WASH to prevent and overcome stunting.

If you have questions about our work to reduce stunting or specifically growth monitoring, please get in touch with us through our communication manager Bram Pauwels bram@maxfoundation.nl

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