THE SUCCESS OF THE NATIONAL NUTRITION STRATEGY OF CAMBODIA OF 2009 IN REDUCING CHILDHOOD UNDERNUTRITION, EVALUATED USING ECONOMETRIC REGRESSION MODELS

Abstract

Although both the causes and effects of childhood malnutrition are well studied, Cambodia continues to have high rates of childhood undernutrition. The National Nutrition Strategy (NNS) was implemented in 2009 by the National Nutrition Program (NNP) to address these challenges. The success of one of the key goals of the policy was evaluated through cross-sectional data across four time points (2000, 2005/2006, 2010, and 2014). The results of economic regression models were applied to discuss the effectiveness of the implementation of the NNS. Six nutritional status indicators, three that described size and weight at birth, and three that described WHO anthropometric indicators, were analyzed. The descriptive data suggested the objectives of the policy goal were achieved, however, in comparison to neighboring Vietnam, the achievement in reducing childhood malnutrition in Cambodia became less clear. Differences in descriptive statistics suggested Vietnam was having a greater impact on its nutrition indicators during the period the policy was in effect in Cambodia. Linear and logistic regressions were performed, and demonstrated the complex relationship between nutrition status indicators and covariates, and informed the more complex estimators. The doubly robust (DR) estimator, inverse probability weighted regression adjustment (IPWRA), suggested the implementation of the policy had an overarching negative impact on anthropometric measures and weight at birth (p<0.05). A nearest-neighbour matching (NNM) model found similar results as the IPWRA analysis, confirming that the treatment had a significant negative effect on most of the nutritional indicators of interest. The negative impact of the policy was probably due to lack of staffing and experience managing large-scale programs of the NNP at time of implementation. The nutritional status of children in Cambodia is progressing, despite the NNS of 2009.