Maternal and child nutrition in Odisha and Jharkhand, two eastern states of India, has remained a pressing public health issue. Factors such as poverty, limited healthcare access, and traditional practices have continued to complicate efforts to improve nutritional outcomes. As Odisha and Jharkhand work to enhance their health indicators, addressing maternal and child nutrition has become a critical focus, and the Tata Steel Foundation (TSF) Nutrition Program in Odisha and Jharkhand aims to tackle this critical challenge: improving maternal and child nutrition in these two states.

To ensure its success, Athena conducted a comprehensive baseline evaluation using a unique methodological approach. Our evaluation focused on a crucial thematic area – understanding the existing nutritional landscape within targeted communities.

To ensure that the evaluation was grounded in community realities, we adopted a participatory approach. This involved working closely with community members to understand their perspectives and needs. By incorporating their insights, we could tailor the evaluation and subsequent program interventions more effectively. We employed a Knowledge, Attitudes, Practices, and Behaviours (KAPB) framework to comprehensively assess community understanding and actions related to nutrition. This framework allowed us to identify gaps in knowledge, understand prevailing attitudes towards nutrition, and assess existing practices.

The scale of the evaluation was a key strength. We surveyed over 8,500 individuals, encompassing a diverse range of demographics. This included mothers of young children, adolescent girls, frontline healthcare workers like Auxiliary Nurse Midwives (ANMs) and Accredited Social Health Activists (ASHAs), and Anganwadi workers – all crucial stakeholders in the program's success. By surveying such a large and representative sample, we gained a comprehensive understanding of the nutritional challenges faced by different segments of the population.

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Comprehensive Anthropometric Measurements

To accurately assess the nutritional status of children, we conducted a series of anthropometric measurements. These included:

• Mid-Upper Arm Circumference (MUAC): This non-invasive technique helps identify acute malnutrition.
• Weight and Height: These measurements were used to calculate weight-for-height, length-for-age, and weight-for-age Z-scores, allowing us to determine prevalence of wasting, severe wasting, and underweight among children according to WHO growth standards.
• Hemoglobin Testing: Finger prick blood tests provided crucial insights into the prevalence of anaemia among adolescent girls and women.

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Data Quality: The Cornerstone of Trustworthy Results

Managing a large-scale evaluation with intricate data collection methods demands unwavering attention to detail. Athena prioritized data quality through a robust data management system. Here's how we ensured accuracy and completeness:

• Regular Data Checks: Data was constantly reviewed to identify and rectify any inconsistencies.
• Internal Research Team Review: Our dedicated team analyzed the data for potential errors and ensured clarity.
• Regular Debriefing Sessions: Consistent interactions with field researchers helped identify anomalies, leading to deeper qualitative exploration and robust findings.
• Dynamic Field Movement Planning: Flexibility in field operations allowed for adjustments based on emerging challenges or opportunities.
• Effective Stakeholder Communication: Timely updates and reminders ensured smooth coordination and cooperation among stakeholders.

This rigorous approach ensured the data collected accurately reflected the nutritional realities on the ground. Additionally, to ensure the highest ethical standards, the study received prior approval from the Institutional Review Board (IRB). This rigorous adherence to ethical guidelines protected participant rights and ensured the integrity of the research process.

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A Foundation for Program Success

The meticulously gathered data served as a vital foundation for the TSF Nutrition Program. This information provided valuable insights into existing malnutrition rates, anaemia prevalence, and community perceptions of nutrition. By capturing this multifaceted picture, we provided TSF with crucial recommendations for the successful implementation of the Nutrition Program, ensuring maximum impact and achieving its goals of improving maternal and child health.

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For more details on the project, contact Trapti Malviya and Rashi Goel.