Learning from the Implementation of the Child Nutrition Program: A Mixed Methods Evaluation of Process

Emily DeLacey; Cally Tann; Tracey Smythe; Nora Groce; Michael Quiring; Elizabeth Allen; Maijargal Gombo; Merzel Demasu-Ay; Batbayar Ochirbat; Marko Kerac

doi:10.3390/children9121965

Learning from the Implementation of the Child Nutrition Program: A Mixed Methods Evaluation of Process

Children (Basel). 2022 Dec 14;9(12):1965. doi: 10.3390/children9121965.

Authors

Emily DeLacey^{1

2

3}, Cally Tann^{3

4

5

6}, Tracey Smythe^{1

7

8}, Nora Groce⁹, Michael Quiring², Elizabeth Allen¹⁰, Maijargal Gombo¹¹, Merzel Demasu-Ay¹², Batbayar Ochirbat¹³, Marko Kerac^{1

3}

Affiliations

¹ Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK.
² Holt International, 250 Country Club Rd, Eugene, OR 97401, USA.
³ Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK.
⁴ Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK.
⁵ Neonatal Medicine, University College London Hospitals NHS Trust, 235 Euston Rd, London NW1 2BU, UK.
⁶ MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene & Tropical Medicine, University of London, Plot 51-59 Nakiwogo Road, Entebbe P.O. Box 49, Uganda.
⁷ International Centre for Evidence in Disability, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK.
⁸ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch 7602, South Africa.
⁹ UCL International Disability Research Centre, Department of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
¹⁰ Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, Keppel Street, London WC1E 7HT, UK.
¹¹ Holt International Representative Office in Mongolia, Chinggis Avenue Mongol TV Tower 905, Sukhbaatar District 1st Khoroo, Ulaanbaatar 14251, Mongolia.
¹² Kaisahang Buhay Foundation, Inc., 1109 10th Ave, Quezon City 1109, Metro Manila, Philippines.
¹³ Health Minister's Office, Ministry of Health, Ulaanbaatar 15160, Mongolia.

Abstract

Nutrition and feeding interventions are important for children’s growth and development. Holt International’s Child Nutrition Program (CNP) is a child nutrition and feeding intervention. This study aims to describe and explore the implementation of CNP in Mongolia and the Philippines using mixed methods including qualitative and quantitative data analysis. The analysis framework was guided by the WHO’s Monitoring the Building Blocks of Health Systems. Key informant interviews (KIIs) were conducted, transcribed, translated and coded. Knowledge, Attitude and Practice Surveys (KAPS) and pre-/post-tests from routine program audit data were analyzed. Analysis of nutrition (Mongolia: 95% CI: 7.5-16.6 (p = < 0.0001), Philippines: 95% CI: 7.6-15.7 (p= < 0.0001)) and feeding (Mongolia: 95% CI: 11.7-23.9 (p = < 0.0001), Philippines: 95% CI: 6.6-16.9 (p = < 0.0001)) tests indicate improvement post-training in both countries. KAPS indicate changes in desired practices from pre-training to post-training. Thematic analysis of KIIs highlight essential components for program implementation and effectiveness, including strong leadership, buy-in, secure funding, reliable supply chains, training and adequate staffing. This evaluation of program implementation highlights successful strategies and challenges in implementing CNP to improve the health of children in Mongolia and the Philippines. Lessons learned from the implementation of CNP can inform growth of the program, scaling strategies and provide insights for similar interventions.

Keywords: caregivers; child health; child nutrition; disease prevention; implementation; intervention programming; service and outcomes; training of trainers.

Grants and funding

This research received no external funding.