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Impact of a Nutrition-based Supplementation Programme Within the Primary Healthcare System to Prevent Child Stunting in Thatta and Sujawal Districts, Sindh, Pakistan (P04-014-19).

Objectives
The objectives of impact evaluation were to assess the prevalence and impact of nutrition-based supplementation on stunting in children under-five year of age.


Methods
Baseline and endline surveys on a sub-set of population in 2014 and 2017 were conducted in two districts of Sindh, Pakistan. Children 6-23 months received a daily ration of 50 g/day of lipid based nutrient supplement-medium quality (LNS-MQ). Children aged 24-59 months received a micronutrient powder sachet containing the RDA for 15 micronutrients every alternate day for at least 6 months.


Results
2195 children at baseline and 2923 at endline were included in analysis. A significant reduction of 10% (45% at baseline; 40% at endline; P = 0.003) was observed in the stunting prevalence among children 6-59 months in intervention areas, but only a 2% reduction (52% at baseline; 51% at endline; P = 0.46) was noted in control areas. There was a significant reduction of 8% in the prevalence of underweight in intervention areas (35% at baseline; 32% at endline; P = 0.05) and a 2% reduction in control areas (45% at baseline; 43% at endline; P = 0.44). Reductions in the anemia prevalence in children 6-59 months was significant in intervention and control areas (P < 0.001). There was a significant decrease of 13% in anemia prevalence (88% at baseline; 75% at endline; P < 0.001) in intervention areas. An 11% reduction in the anemia prevalence was observed in children 6-59 months (87% at baseline; 77% at endline; P < 0.001) in control areas.


Conclusions
The significant 10% reduction in the stunting prevalence shows the ability of nutrition-based supplementation in achieving nutrition gains in the short term in children 6-59 months through the primary healthcare system. This is an effective method to protect children from stunting caused by food insecurity and limited access to age-appropriate nutritious foods in Pakistan and similar settings.


Funding Sources
World Food Programme, Pakistan.