The impact on child wasting of a capacity building project implemented by community and district health staff in rural Lao PDR.

Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland areas. We implemented a 3-year health/nutrition project in 12 villages in the highlands of Savannakhet province to reduce acute malnutrition in children. Volunteer nutrition teams in each village monitored child growth and promoted healthy feeding practices; a multisectoral district committee conducted monthly outreach to assess child growth, manage acute malnutrition and deliver primary health care services. We conducted a cross-sectional assessment before project activities began and at the end of the project. The baseline survey randomly sampled 60% of all households; the endline assessment aimed to survey all eligible registered participants. Anthropometric measures were taken from children aged 6-59 months; mothers with children aged <12 months were asked about infant feeding practices, antenatal and post-partum care; and child immunizations were recorded for children aged between 0-23 months. At baseline, 721 households were sampled, while the endline assessment surveyed between 82% and 100% of eligible participants in each age group. Acute malnutrition reduced from 12.4% (95% CI: 10.4- 14.3) to 6.1% (4.9-7.3). Unhealthy feeding practices declined: in 2008, 40.0% (34.7-45.3) of mothers breastfed their newborn within 2 hours of birth and 30.8% (25.7-35.8) threw the colostrum away; in 2011, these figures were 72% and 8% respectively. Maternal care and child immunisation coverage also improved. Improving the health environment and child feeding practices appears to have markedly reduced the level of wasting. Unsafe feeding practices were common but readily changed by the community-based nutrition teams.