What works and why? Evaluation of a community nutrition programme in Kenya.

OBJECTIVE To investigate the nutritional impact of a community-based programme that focused on social cohesion and action. DESIGN The change in nutritional status of children aged 12–60 months was examined over a period of 3 years in Makueni District in Eastern Province of Kenya in six communities in which an intervention programme of Participatory Learning and Action was introduced and in ten communities in which only basic preparations were made but no intervention was started. SETTING The intervention was part of the Government of Kenya Community Based Nutrition Programme and was supported by the Government of Denmark. SUBJECTS Children aged 12–60 months. RESULTS Among communities without intervention there were similar levels of underweight (mean Z-score: −1·63 v. −1·50 (NS); % with Z-score<–2: 36·6% v. 34·5% (NS)) and stunting (mean Z-score: −2·0 v. −1·99 (NS); % with Z-score<–2: 44·3% and 47·4% (NS)) at baseline and after 3 years. By contrast, among communities who had received interventions, there were significant improvements after 3 years in the levels of underweight (mean Z-score: −1·66 v. −1·37 (P<0·02); % with Z-score <–2: 42·9% v. 31·4% (P<0·035)) and stunting (mean Z-score: −2·05 v. −1·59 (P<0·05); % with Z-score<–2: 52·7% v. 39·7% (P<0·02)). CONCLUSIONS The results indicate considerable potential for using Participatory Learning and Action as a community-based approach to effectively address child undernutrition. It is suggested that these interventions are developed, implemented and evaluated more widely as a mean of tackling childhood undernutrition and improving child survival and development.