Intensifying efforts to reduce child malnutrition in India: an evaluation of the Dular program in Jharkhand, India.

BACKGROUND The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition. OBJECTIVES AND METHOD An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status. RESULTS Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages. CONCLUSIONS Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.