Evidence - SBC Impact
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Evidence - SBC Impact
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Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: A randomized effectiveness study

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Rivera, J. A., D. Sotres-Alvarez, et al. (2004). "Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: A randomized effectiveness study." Journal of the American Medical Association 291(21): 2563-2570.

Context: Malnutrition causes death and impaired health in millions of children. Existing interventions are effective under controlled conditions; however, little information is available on their effectiveness in large-scale programs.

Objective: To document the short-term nutritional impact of a large-scale, incentive-based development program in Mexico (Progresa), which included a nutritional component.

Design, Setting, and Participants: A randomized effectiveness study of 347 communities randomly assigned to immediate incorporation to the program in 1998 (intervention group; n = 205) or to incorporation in 1999 (crossover intervention group; n = 142). A random sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward. Participants were from low-income households in poor rural communities in 6 central Mexican states. Children (N = 650) 12 months of age or younger (n = 373 intervention group; n = 277 crossover intervention group) were included in the analyses.

Intervention: Children and pregnant and lactating women in participating households received fortified nutrition supplements, and the families received nutrition education, health care, and cash transfers.

Main Outcome Measures: Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children.

Results: Progresa was associated with better growth in height among the poorest and younger infants. Age- and length-adjusted height was greater by 1.1 cm (26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group) among infants younger than 6 months at baseline and who lived in the poorest households. After 1 year, mean hemoglobin values were higher in the intervention group (11.12 g/dL; 95% confidence interval [CI], 10.9-11.3 g/dL) than in the crossover intervention group (10.75 g/dL; 95% CI, 10.5-11.0 g/dL) who had not yet received the benefits of the intervention (P = .01). There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention. The age-adjusted rate of anemia (hemoglobin level <11 g/dL) in 1999 was higher in the crossover intervention group than in the intervention group (54.9% vs 44.3%; P = .03), whereas in 2000 the difference was not significant (23.0% vs 25.8%, respectively; P = .40).

Conclusion: Progresa, a large-scale, incentive-based development program with a nutritional intervention, is associated with better growth and lower rates of anemia in low-income, rural infants and children in Mexico.

Why the focus on direct impact data?

A common challenge from policy makers, funders, community members, people directly experiencing development issues, and governments is: Demonstrate your Impact. Prove that what you are doing works. The high quality, highly credible data presented on the cards below is designed to help you answer that question for your social change, behaviour change, community engagement, communication and media for development, strategy formulation, policy engagement and funding initiatives. At this link filter the research data to your specific interests and priorities

Why a playing cards design?

There is a physical pack of cards with this data (to get a copy please request through the comment form for any card). The card approach allows for easy identification and selection of relevant direct impact data in any context. For example if talking with a donor and you need to identify proof of impact say "take a look at the 7 of Hearts". Quick access can be provided to high-quality data for many areas of your work – funding, planning, policy, advocacy, community dialogue, training, partner engagement, and more. A card deck is also engaging, easy to use and share, a conversation starter, and a resource - and they are fun and different. So we kept that design for the online images as it can serve similar purposes. 

What are the criteria for inclusion?

The impact data presented meets the following high standard for inclusion criteria:

  • Positive change or trend in a priority development issue;
  • Social change or behaviour change strategy or process;
  • Randomized Control Trial or Systematic Review methodology;
  • High quality peer review journal published;
  • Numeric impact data point
  • Published since 2010.