Evaluating Nutrition in Sikasso, Mali
Meet Natalie Roschnik.
She is collaborating with the Strategic Impact Evaluation Fund (SIEF) to evaluate an integrated nutrition, malaria, and early childhood development program in Mali led by Save the Children. The evaluation is taking place in Sikasso region, assessing the impact of daily micronutrient supplements plus parent education and seasonal malaria treatment. The hope is that combining treatments will boost children’s brain and body development
In a recent conversation with SIEF, Roschnik talked about why she’s passionate about evaluation and the unexpected lessons that being a parent have brought to her work.
How did you get into ‘impact evaluation’?
I completed a Master’s degree in nutrition, and then spent two years working in Mali and the Sahel with Save the Children. I was focusing on health and nutrition programs for school children.
At the time, we had a sponsor-a-child program, which was one of our main sources of funding. Malaria kills a lot of school-age children every year and it wasn’t unusual for us to have to tell sponsors in the U.S. that the children they were sending money for had died. In many cases, the reason was malaria.
We needed solutions that worked—and evidence—of what was working or wasn’t for the school age population, kids who were not targeted by standard government malaria prevention and treatment programs. So we partnered with the London School of Hygiene and Tropical Medicine on a study in Mali to evaluate school-based solutions.
How did you go about doing that?
The researchers suggested that, in addition to malaria education, we train teachers to treat all schoolchildren regardless of infection at the end of the malaria transmission season—similar to deworming programs in schools, but for malaria. We used a randomized control trial design to measure the impact on children’s health and education.
We also did a baseline survey to measure children’s health and cognitive functions. A big majority—80 percent—were infected with the parasites that cause malaria, but only two percent had visible symptoms like a fever. These children were still at risk of becoming anemic, which can be bad for how they concentrate and learn at school.
Did you see any difference in the treatment groups?
The impact of treating the children was huge: there was a dramatic decrease in malaria infection, from 80 percent to less than three percent, and anemia dropped from more than 50 percent to less than 35 percent. The effects were sustained until the end of the school year. We also saw a significant improvement in cognitive function, with children more likely to pay attention for longer at school. Among children in the control group, meaning kids who were not automatically treated in school for malaria, the infection rate remained above 70 percent.
The randomized control trial made the difference in deciding what to do next. Based on the results, Save the Children and the Government of Mail have expanded the intervention to around 400 schools in the area.
You have three children… has your work with kids’ health and learning had an impact on your life as a parent?
Being a parent has been a good reality check. It reminds me just how difficult it is to be a ‘perfect parent’ in your everyday life. I struggle to keep up with the health and education needs of my own children: helping them with homework, remembering vaccinations, giving them healthy food, and making sure they’re getting enough physical activity. We have so many expectations on parents in the communities where we work and load them up with messages on what they should be doing, often without thinking about what is doable and feasible in their everyday life.
What motivates you every day?
I work with great people and it’s exciting to be able to make a difference. Evaluation has given visibility to the work we do: anecdotal evidence only goes so far, and so having numbers to go with stories from the field makes the work we do so much more compelling.