Evaluating a Nutrition Assistance and Education Program in the Dominican Republic

Abstract

Introduction: The Dominican Ranks 79th in the world for high rates of under five year mortality at 33 deaths per 1000 live births. The Ninos Primeros en Salud (NPS) in Consuelo, DR has an extensive Nutrition Program for children 0-5 years to address food insecurity and malnutrition with nutrition education, regular weight checks, home visits, micronutrient supplementation and supplemental food packages in an attempt to decrease mortality amount 0-5 year olds. Objectives: The primary aim of this study was to compare the two groups (nutrition intervention group and healthy reference group) to determine if there were differences in demographic characteristics among children receiving care at NPS. The secondary aim was to evaluate the Nutrition Program at NPS during the first nine months of the program by observing changes in wasting, weight for height z-score (WHZ), weight for age z-score (WAZ) and height for age z-score (HAZ) in children participating in the nutrition intervention program compared to the healthy reference group. The tertiary aim was to determine if there were differences in outcomes of wasting and WAZ in the Nutrition intervention group in relation to household size. Study Design: Observational study with propensity score frequency matching in healthy reference group. Baseline and up to nine months follow up data were examined on all patients being seen at NPS (n=75) consisting of age, weight, height and birth weight.. Baseline and monthly follow up was also collected on patients enrolled in the nutrition program (n=53) with monthly data consisting of weight, height, age and number living in household. All data were de-identified. Results: The intervention group and healthy reference group differed only in age and birth weight at baseline after matching. The intervention group showed statistically significant improvement in all three areas of weight anthropometric measurements (i.e. wasting, WAZ and WHZ) from pre intervention to post intervention when compared to the healthy reference group. Both the intervention and reference group showed statistically significant decreases in HAZ, with the intervention group showing a decrease in HAZ compared to the healthy reference group. The intervention group also showed significant worsening in measure of stunting over the follow up period. Outcomes measurements of wasting and WAZ did not differ based on household size. Conclusions: The intervention was successful in increasing the weight of malnourished children. However, it appears that the intervention had no positive effect on increasing linear growth. Further investigation is needed to determine the impact of the nutrition intervention on malnutrition, specifically linear growth.