What is the Right Indicator to Evaluate Impact of Interventions? Examples from a Rice Fortification Trial in Cambodia.
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Date
2015
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Abstract
Objectives: Large-scale programs often use proxy indicators for evaluation purposes but little is
known on whether use of these indicators might lead to erroneous conclusions regarding impact of
programs. In the FORISCA-UltraRice+NutriRice trial in Cambodia, fortified rice was introduced
through the WFP schoolmeal program (WFP-SMP). A wide range of impact indicators collected
during the study was explored to test the usefulness of 2 proxy indicators (anemia and stunting) for
program evaluation.
Methods: In a placebo-controlled, double blinded trial, 20 schools (n=9500) were randomly
allocated to no SMP (control, 4 schools), normal schoolmeal (placebo, 4 schools) or a schoolmeal
with fortified rice (3 different types, 4 schools each). Data on absenteeism and morbidity was
available for all schoolchildren, whereas biochemical data (hemoglobin, iron, zinc and vitamin A
status), anthropometry, parasite infection and cognitive performance was available for ~25% of children.
Results: At baseline, anemia prevalence was significantly lower in non-SMP (9.5% vs 16.6%,
P<0.05) and iron status significantly higher in non-SMP schools than in intervention schools
(P<0.005). Stunting prevalence was high (41.5%) and not different among the schools. After 6
months of consumption, fortified rice had no overall impact on anemia prevalence or hemoglobin
concentrations, but improved micronutrient status and cognitive performance in some intervention
groups.
Conclusions: Anemia prevalence is a valid indicator to select schools for SMP, but stunting
prevalence had little value in this study. Changes in anemia prevalence did not correspond to
changes in functional outcomes, showing that program evaluation requires better proxy indicators.
Funded by USDA/FAS, WFP-DSM consortium and IRD.
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Kuong Khov, Fiorentino Marion, Perignon Marlene, Chamnan Chhoun, Parker Megan, Burja Kurt, Kong Kannitha, Berger Jacques, Wieringa Frank. What is the Right Indicator to Evaluate Impact of Interventions? Examples from a Rice Fortification Trial in Cambodia. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 760-761.