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Impact of Intervention in Mombassa

This study examines the impact of an intervention in Mombassa on stunting rates and domestic violence. Comparisons were made between intervention and control areas to assess changes over time.

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Impact of Intervention in Mombassa

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  1. Impact of Intervention in Mombassa

  2. Nationally in 2011. the rates for severe stunting were about 16% for boys and 13% for girls; and for moderate stunting they are about 38% for boys and about 33% for girls. • Rates in the two slum areas were higher than the national rates, much higher than the rates in the MICS Mombassa Informal Settlement Survey • Severe stunting: about 21% for boys and 14% for girls with boys rates higher in Chaani and girls rates higher in Kongowea • Moderate stunting: about 44% for boys and 40% for girls with both rates higher in Chaani Comparing Stunting Rates at Baseline

  3. We have carried out a before-after, case-control study. The intervention areas was Chaani, the control area was Kongowea; the first wave of data was in July 2011, the second in June 2013 • The classic – although relatively new! - way to assess impact of the intervention is to say: • If the areas are well-matched then any changes – independent of the intervention - should be similar in the control and intervention areas • If there is a positive impact of the intervention, then the situation should have improved more in the intervention area, and vice versa if there is a negative impact Assessing Impact of Intervention I

  4. Then one compares the change in the intervention area against the change in the control area (the procedure is known as difference-in-difference). This procedure has been applied to the rates of moderate and severe stunting in Chaani and Kongowea and to rates of domestic violence in the two years • But is is always crucial to check that there have been no significant changes in other factors that are known to affect child health and specifically nutrition that have differentially affected control and intervention areas. In particular, we are concerned with any possible changes in any known structural and social determinants in the two areas (e.g. Environment, food distribution, housing, transport, social security, etc. Assessing Impact of the Intervention II

  5. N < -3 < -2 Mean SD CHAANI • 2013 Male 220 13.2% 34.5% -1.33 1.42 • 2011 Male 197 18.3% 40.6% -1.69 1.45 • 2013 Female 256 11.7% 32.8% -1.41 1.29 • 2011 Female 176 13.6% 31.3% -1.46 1.37 KONGOWEA • 2013 Male 268 10.8% 31.3% -1.27 1.47 • 2011 Male 208 17.8% 38.5% -1.65 1.40 • 2013 Female 255 9.0% 27.5% -1.28 1.31 • 2011 Female 229 11.8% 38.9% -1.49 1.39 STUNTING 2013 AND 2011

  6. Possible intermediate factors • Education • Employment • Food distribution, • Food security/ coping strategies • Housing • Income • Population change /immigration • Social security, • Transport Of these, the only ones which might change quickly are employment, food consumption, food security, income, population change EXPLANATIONS: SDH

  7. Respondents were asked the frequency of eating different food items. There have been small drops for many items in both areas but the most spectacular, which confirms data in the previous table , is the reduction in eating fish in Chaani from nearly 6 to under 2 days a week COPING STRATEGIES Respondents were asked about their coping strategies when food was short. The use of all the main strategies has increased in both areas but much more in Chaani

  8. Chianti 2011 Kongowea 2011 Difference in 2011 (C-K) • Chaani 2013 Kongowea 2013 Difference in 2013 (C-K) • Difference in Difference (C2-K2) – (C1-K1); negative means intervention improved more than control 1a Jealous talking to other men42384 29 2540 1b Accuses you of Unfaithful 18 180 24 2133 1c not meet female friends 19 163 12 930 1e Knowing where you are 36 297 27 243 -4 8 Drink alcohol 35 23 12 38 34 4-8 2a1 Humiliates you 21 147 43 3492 2a3 Insults you 24 273 52 4485 3a1 Push or shake you 3 14-1 43 291415 3a2 Slap you 25 37-12 69 541527 3a3 Twist arm, pull hair 25 37-12 31 22921 VIOLENCE 2011 2013

  9. For both moderate and severe stunting and for levels of physical domestic violence, rates have improved more in control than in intervention. • For domestic violence, this may well be a reporting problem; more attention paid to physical domestic violence so respondents are more likely to report • But, given that height was measured on both occasions, that cannot be the explanation for the negative results for moderate and severe stunting • Changes in employment and income, food consumption and expenditure and coping strategies Summary and Interpretations

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