PO1521

1. K. K. Saha1; R. Rawat2; A. Khaled1; R. Haque3; K. Afsana3; T. G. Sanghvi4; M. T. Ruel2; P. Menon5 1International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh; 2IFPRI, Washington DC, USA; 3BRAC, Dhaka, Bangladesh, 4FHI360, Dhaka, Bangladesh; 5IFPRI, New Delhi, India Background and Objectives: • In Bangladesh, the Alive & Thrive (A&T) initiative aims to improve infant and young child feeding (IYCF) practices of mothers through intensive counseling by frontline health workers (FHWs) and a nationwide mass media campaign. • A comprehensive IYCF training and performance improvement package (3-day classroom discussion, 3-day field practice, monthly refreshers, routine supervision and performance-based incentives) for FHWs (Health Volunteer called ShasthyaSebika and IYCF Promoter called PushtiKormi) was developed based on formative research. • Mass media campaign was done through six TV commercials on different IYCF themes. • We evaluated the impact of this performance improvement package on FHWs’ knowledge of IYCF. A COMPREHENSIVE TRAINING AND SUPERVISION PROGRAM IMPROVED FRONTLINE HEALTH WORKERS’ KNOWLEDGE OF INFANT AND YOUNG CHILD FEEDING IN RURAL BANGLADESH Methods: • In 2011, we conducted a process evaluation in the context of a cluster-randomized impact evaluation design comparing FHWs’ knowledge of IYCF in A&T intensive and A&T non-intensive areas (10 sub-districts each group). • FHWs in A&T intensive areas received IYCF training and supervision; FHWs in both areas were exposed to A&T mass media campaign. • Data were collected from FHWs both at baseline in 2010 and in 2011, a year after the program implementation in 20 sub-districts. • We captured FHWs’ knowledge of IYCF over a year. Results: Figure 1: Topics covered in training of ShasthyaSebika Figure 2: Perceptions of ShasthyaSebika about breastfeeding ** p < 0.01, *** p < 0.001 * p < 0.05, *** p < 0.001 • At baseline, FHWs’ IYCF knowledge was low with no significant difference in A&T intensive and non-intensive areas, with little exposure to IYCF topics at pre-service (5.5%) or refresher (2.0%) training. • In 2011, IYCF was a key topic of discussion in A&T intensive areas (91.0%). • In A&T intensive areas, FHWs’ IYCF knowledge improved significantly. Knowledge of early initiation of breastfeeding increased from 27.1% to 63.2%, knowledge of timing of introduction of complementary foods improved, particularly for animal source food (mean age 9.6±2.6 months at baseline vs. 6.8±1.4 months at follow-up). • Similarly, knowledge of age-appropriate frequency and quantity of complementary feeding improved in A&T intensive areas. Figure 3: Knowledge of foods to be fed to children after 6 months of age * p < 0.05 Conclusions: Comprehensive training with performance improvement package improved FHWs’ IYCF-related knowledge, thus assuring that a critical point in the impact pathway for this intervention was in place. This innovative approach underscores the importance of supervision, on job refresher training and performance based incentives to enhance motivation of FHWs and improving their knowledge of IYCF. Keywords: IYCF, frontline health workers, Alive & Thrive, Bangladesh. Funding: Bill and Melinda Gates Foundation, through Alive & Thrive, managed by FHI360. PO1521