Saxton, JC; (2013) Assessing the potential of community mobilisation with women's groups to improve child growth among underserved tribal communities of Eastern India. Doctoral thesis (PhD), UCL (University College London).

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Abstract

Background: India is home to one-third of the world’s undernourished children. Rural tribal areas are disproportionately affected. Community-based behaviour change interventions are central to addressing undernutrition. Most interventions have used didactic educational methods but have had a limited impact; fewer studies have tested participatory approaches. This thesis explores the potential of a participatory intervention to reduce child undernutrition in rural tribal communities of Eastern India. Methods: We conducted a cross-sectional nutrition survey of 36 village-clusters in three districts of Jharkhand and Orissa: 18 clusters had been exposed to community mobilisation with women’s groups to improve child health and nutrition; 18 control clusters matched the intervention areas on population and health-service characteristics. We also conducted focus groups with caregivers of young children. Results: There were no group differences for child anthropometry. Levels of undernutrition were extremely high: 40% of children were experiencing global acute malnutrition, 60% were stunted, and 24% had mid-arm-circumference measurements in the moderate-severe malnutrition category. There were significant group differences for hand washing, water treatment, birth spacing, measles vaccination and awareness of child undernutrition that favoured the intervention group; there were no differences for child feeding practices, health-service uptake or child morbidity. The analyses identified a multitude of undernutrition determinants including strong protective effects of hand washing, and diarrhoea as a major risk factor. The focus groups revealed extreme food insecurity, problematic feeding and hygiene practices, and inadequate health services. Conclusion: Community mobilisation with women’s groups does not appear to have reduced child undernutrition in this context, but has the potential to improve important nutrition behaviours. There is scope to improve and combine this intervention with complementary strategies, but until the wider problems of food insecurity, poverty and poor health-services are addressed community mobilisation with women’s groups, on its own, is unlikely to meaningfully impact on undernutrition.

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