Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project: Studying the integration of maternal, infant, and young child nutrition (MIYCN) with agriculture, water, sanitation, and hygiene (WASH), or HIV programs

The project is supported by the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031 and is managed by JSI Research & Training Institute, Inc. Large-scale programs to promote MIYCN are urgently needed to address the global burden of undernutrition in developing countries. Growing evidence supports specific interventions, including the promotion of breastfeeding, complementary feeding, and handwashing strategies, for the improvement of nutrition and nutrition-related outcomes. However, multi-sector approaches that offer the greatest potential for optimal impact have not been evaluated in the context of rigorous evaluations of program effectiveness. Evidence gaps remain around how to effectively integrate MIYCN programming with other sectors, including agriculture, WASH, or HIV programs. Household food production strategies, for example, appear to significantly improve diet patterns and vitamin A intakes for both women and children, but robust studies to measure and document changes in nutrition indicators have not been conducted. A review of strategies for integrating health care services suggested that "adding on" services or creating linkages across sectors may enhance the utilization and outputs of healthcare delivery, but the impact on maternal and/or child health status remains unclear. This study seeks to rigorously examine whether community-based integration of MIYCN with agriculture, WASH, or HIV programs is feasible, effective, and synergistic to promote the adoption of key MIYCN practices. The study aims to provide a better understanding of the benefits or limitations of an integrated approach, which would be critical to inform the design of large-scale multi-sector programs in resource-constrained settings. The research objectives of the study include examining the performance of an intervention that delivers MIYCN integrated with agriculture, WASH, or HIV programs, and comparing the delivery of the integrated MIYCN program to program(s) offering only single sector interventions. The study will focus on aspects of provision, utilization, coverage, and impact in a given population to determine if anticipated changes in nutrition or nutrition indicators occurred. The study will also examine the adequacy of MIYCN + HIV integrated services and compare them to standard or existing HIV services.