Impact of facility based versus home based growth monitoring and promotion programs on child nutritional status in rural Bangladesh

Abstract

The delivery platform for growth monitoring and promotion (GMP) programs to improve child nutrition remains debated. This study compared the impact of facility-based plus non-governmental organization supported home-based GMP (FGMP + NGO-supported HGMP) versus facility-based GMP (FGMP) on child nutritional status in rural Bangladesh. Using a quasi-experimental design, 1,519 children aged 6-12 months were enrolled in each program and assessed at baseline and after 12 months. The primary outcome was linear growth (length-for-age Z-scores, LAZ), while secondary outcomes included weight-for-age (WAZ), weight-for-height (WHZ), stunting, wasting, and underweight prevalence, minimum dietary diversity, minimum meal frequency, and caregivers' complementary feeding practices. Child linear growth (Difference-in-difference, D-I-D: -4.5; 95% CI: -15.2, 6.1) and weight (D-I-D: -3.5; 95% CI: -11.7, 4.6) faltered in both groups, with no significant differences between the programs. Stunting (D-I-D: 2.8%; 95% CI: -1.3, 7.1) and wasting (D-I-D: 0.43%; 95% CI: -3.2, 4.1) prevalence increased equally across programs. Underweight prevalence rose more in FGMP + NGO-supported HGMP (D-I-D: 4.7%; 95% CI: 1.7,7.8) than in FGMP programs. Caregivers in FGMP areas showed slight improvements in complementary feeding practices (D-I-D: -1.4%; 95% CI:-6.5, 3.7) and significantly improved meal frequency (D-I-D: -4.7%; 95% CI: -9.1,-0.3). No significant differences were observed in minimum dietary diversity (D-I-D: -1.5%; 95% CI: -6.1, 3.1) or acceptable diet (D-I-D: -2.0%; 95% CI: -6.6, 2.6) between the programs. Findings highlight the need to strengthen both FGMP and FGMP + NGO-supported HGMP programs by actively engaging caregivers and incorporating the influential role of family members and local social networks, which appeared to have a stronger impact on child feeding practices than GMP providers.