CARE/Dominican Republic : maternal child health II project -- 1993-1994 impact study

Evaluation covers the period 1993-3/96. An ambitious baseline study was completed at the start of the project, including a health/family planning (FP) survey covering 16,906 households (approximately 40% of the target population) and a cross-indexed Knowledge, Beliefs, Attitude and Practices (KBAP) survey covering 2,847 families. In September 1995, the KBAP instrument was re-administered to 904 project families and 175 control families. The instrument addresses indicators and analyzes findings in FP practices, nutritional status, MCH care, and breastfeeding. Results in FP prove, with extremely high levels of statistical validity, four key findings. (1) In project communities, non-FP users fell by nearly a third. (2) The predominant mix of FP choices previously available to project participants (sporadic pill use followed by early sterilization) has changed dramatically. (3) A nearly 50% reduction in the percentage of mothers at risk of unwanted pregnancies was verified. (4) A 36% increase in birth spacing to more than 24 months has also been documented. Non-project explanation of causation has been ruled out. Additionally, program outreach has increased to over three-quarters of the rural target population, and women's participation in community organizations and assumption of leadership are up significantly. Statistically significant changes in nutrition were found in three areas. (1) While overall low birth weight did not improve, children whose mothers had participated in project activities demonstrated a decrease of 2.5% in low birthweight, nearly a fifth. (2) Growth card use is up substantially, but mothers' ability to read the card is down. (3) Severe and moderate malnutrition has declined in project communities, 3% in 1-11 month old children, 4.2% in 12-23 month old children, and 3.7% in 24-35 month old children. Impact in MCH care was found in six areas. (1) Prenatal care during the first trimester increased in project villages. Post partum control was much lower, but held steady in project villages, against a declining trend in control communities. (2) The project had high impact in increasing project mothers' visits to Ministry of Health (MOH) rural clinic. (3) Children's vaccinations are dramatically higher in all villages, in part due to the project's logistical assistance to national MOH vaccination campaigns. Three of four children had all boosters against DPT and polio; nine of ten for BCG; eight of ten for measles. Six of ten have received all childhood vaccinations. (4) There has been no reduction in the incidence of diarrhea or acute respiratory infection (ARI), but there has been a statistically significant improvement in project mothers increasing the length of oral rehydration solution and the frequency of its administration to four or more times per day. A significant number of children had diarrhea for three days or less. (5) A statistically significant number of project mothers take their children to the rural clinics with ARI than heretofore. (6) A significant and substantive increase was verified in the proportion of mothers who can recognize three to six signs of dehydration. Impact in breastfeeding and infant nutrition was found in three areas. (1) Exclusive breastfeeding for children under 6 months of age at time of survey has more than doubled, to 26%; results for children under 4 months old are even better. Formula and bottle use in project villages have decreased by 17%. (2) Administration of laxative to newborns and infants in project villages has gone down by 7.4% to under 40%. (3) Length of breastfeeding has increased by nearly 12% in project and control villages. Project designers hoped to demonstrate that food-assisted programming could be shown to be as successful as the best of development programming anywhere in the world. FP results are dramatic at nearly unprecedented levels of statistical confidence. Nutrition results indicate that carefully targeted interventions can reduce malnutrition through education and better health services, even without a major reduction in poverty. The project has been highly successful in MCH interventions, with a likely influence on decreased mortality. Finally, the project has had significant impact on improving feeding practices at birth. (Author abstract)