A cluster-randomized, controlled trial of nutritional supplementation and promotion of responsive parenting in Madagascar: the MAHAY study design and rationale (original) (raw)
Related papers
Improving nutritional status through behavioral change : lessons from Madagascar
2008
We provide evidence for effects of a large scale intervention that focuses on quality of nutritional and child-care inputs during the early stages of life. Our empirical strategy uses a combination of double -difference and weighting estimators in a longitudinal survey to address the purposive placement of participating communities and estimate the effect of the availability of the program at the community level on nutritional outcomes. We find that the program helped 0-5 years old children, in the participating communities to bridge their gap in weight for age z-score and the incidence of underweight. The program also had significant effects in protecting long term nutritional outcomes (height for age z-scores and incidence of stunting) against an underlying negative trend in the absence of the program. Importantly, the effect of the program exhibits substantial heterogeneity: gains in nutritional outcomes are larger for more educated mothers and for villages with better infrastructure. The results are suggestive of important complementarities between child care, maternal education and community infrastructure. (JEL I12, I18, J13, O15)
Improving nutritional status through behavioural change: lessons from Madagascar
Journal of Development Effectiveness, 2009
We provide evidence for effects of a large scale intervention that focuses on quality of nutritional and child-care inputs during the early stages of life. Our empirical strategy uses a combination of double -difference and weighting estimators in a longitudinal survey to address the purposive placement of participating communities and estimate the effect of the availability of the program at the community level on nutritional outcomes. We find that the program helped 0-5 years old children, in the participating communities to bridge their gap in weight for age z-score and the incidence of underweight. The program also had significant effects in protecting long term nutritional outcomes (height for age z-scores and incidence of stunting) against an underlying negative trend in the absence of the program. Importantly, the effect of the program exhibits substantial heterogeneity: gains in nutritional outcomes are larger for more educated mothers and for villages with better infrastructure. The results are suggestive of important complementarities between child care, maternal education and community infrastructure. (JEL I12, I18, J13, O15)
Maternal & Child Nutrition, 2013
Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster-randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home-visits would increase children's dietary intake, growth and development compared with home-visit-complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother-infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi-weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12-month intervention to the CFG and RCF&PG significantly (P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0-0.4] in the CFG (but not RCF&PG) and increased (P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8-5.3) in the RCF&PG (but not CFG) compared with CG. Community-based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food-secure rural Indian families.
BMC Pediatrics, 2022
Background Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development. Methods We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional d...
Nutrients
Background: Stunting has been a public health problem in several developing countries including Indonesia. One of the strategies to reduce stunting was family assistance. This study was aimed to estimate the effect of family assistance by using an integrative nutrition package through home visits on the growth and development of stunted children. Method: This was an experimental study using pre-test post-test with control group design, conducted in Yogyakarta, Indonesia, on March to May 2022. The intervention group was provided an integrative nutrition package (INP) including maternal education, behavioral change through home visit, as well as monitoring children’s outcome, while the control group was asked to read and follow child care procedure in the maternal and child health (MCH) book as a standard procedure. Both groups were visited by trained health volunteers and had a complementary feeding (CF) package weekly for four weeks. The outcomes of this study were the maternal outc...
European Journal of Clinical Nutrition, 2009
Background/Objectives: The assessment of child feeding practices has received renewed attention through the development of an infant and child feeding index (ICFI). However, the advantages and shortcomings of such a summary index are still not well known. The aim of this study was to assess the usefulness of ICFI as an analytical tool (1) by studying its association with complementary food energy intake and mean micronutrient density adequacy (MMDA) and (2) by testing whether ICFI and its components are associated with length-for-age z-score (LAZ) of 6-23 months children in urban Madagascar. Subjects/Methods: ICFI was constructed using data from questionnaires on feeding practices and quantitative 24-h recalls (n ¼ 1589). Multivariate analysis was used to control for household wealth and other confounding factors. Results: ICFI was positively correlated with complementary food energy intake (Po0.0001) and MMDA (Po0.0001). ICFI was associated with LAZ among 6-8 months children (P ¼ 0.02). For all ages combined, there was a tendency towards an association that did not reach statistical significance (P ¼ 0.08). Among feeding practices that formed ICFI, breastfeeding was associated with LAZ (P ¼ 0.03) but not in the expected direction with þ 0.16 z-score difference in favour of non-breast-fed children. When breastfeeding was removed and introduced separately into the multivariate model, the relationship between the modified ICFI and LAZ became significant (P ¼ 0.02). Conclusions: Findings suggest that the ICFI could be a useful analytical tool, which needs however to be constructed according to its final use and which should be adapted to each context.
BMC Public Health, 2014
Background Strategies to improve infant and young child nutrition in low-and middle-income countries need to be implemented at scale. We contextualised and packaged successful strategies into a feasible intervention for implementation in rural Tanzania. Opportunities that can optimise delivery of the intervention and encourage behaviour change include mothers willingness to modifying practices; support of family members; seasonal availability and accessibility of foods; established setup of village peers and functioning health system. The primary objective of the study is to evaluate the effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth as compared to routine health education. Methods/Design A parallel cluster randomised controlled trial will be conducted in rural central Tanzania in 9 intervention and 9 control villages. The control group will receive routine health education offered monthly by health staff at health facilities. The intervention group will receive a nutrition education package in addition to the routine health education. The education package is comprised of four components: 1) education and counselling of mothers, 2) training community-based nutrition counsellors and monthly home visits, 3) sensitisation meetings with health staff and family members, and 4) supervision of community-based nutrition counsellors. The duration of the intervention is 9 months and infants will be recruited at 6 months of age. Primary outcome (linear growth as length-forage Z-scores) and secondary outcomes (changes in weight-for-length Z-scores; mean intake of energy, fat, iron and zinc from complementary foods; proportion of children consuming 4 or more food groups and recommended number of semi-solid/soft meals and snacks per day; maternal level of knowledge and performance of recommended practices) will be assessed at baseline and ages 9, 12 and 15 months. Process evaluation will document reach, dose and fidelity of the intervention and context at 8 and 15 months. Discussion Results of the trial will provide evidence of the effectiveness of the nutrition education package in community settings of rural Tanzania. They will provide recommendations for strengthening the nutrition component of health education in child health services.
2019
Background: Madagascar has one of the highest rates of stunting and at-risk child development in the world:50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III), supported by the World Bank, was initiated to help address stunting and developmental delay. PIVOT, a health care NGO operating in collaboration with the MOH, conducts a longitudinal study, the IHOPE, to assess the population level impact of their collaborative health system strengthening activities on the rural district of Ifanadiana in southeastern Madagascar. We report factors associated with risk to developmental delay in children ages 3 and 4 years old in Ifanadiana district in 2016. Methods: The household survey data are from a cross-sectional analysis of a one wave of panel data in 2016, at the time of the initiation of PNAN III. Women ages 15 to 49 were interviewed, using the Multiple Indicator Cluster Survey (MICS) Early Child Development Indicat...
Trials, 2024
Background Globally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers. Methods Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a communitybased cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers' groups, with or without fathers' groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers' and fathers' groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers' groups receiving a nutrition program, (2) mothers' groups receiving a bundled nutrition and parenting program, (3) mothers' and fathers' groups receiving a nutrition program, (4) mothers' and fathers' groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention). Discussion EFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes. Trial registration ClinicalTrials.gov NCT03759821. Registered on
Background:Almost a quarter of children under the age of five in low- and middle-income countries (LMICs) currently experience growth faltering. Early childhood stunting (height/length-for-age z-score < -2) is associated with a range of adverse later life outcomes including reduced cognitive development, poor school achievement and increased probability of living in poverty as adults. Few effective interventions are currently available to address stunting in LMICs. Methods: We will conduct a 2x2 cluster-randomized factorial trial with ~2300 caregiver-child dyads residing in 280 communities (clusters) located in Luapula, Lusaka, and Southern Provinces of Zambia. Clusters will be randomized into four groups each comprising 70 clusters with ~560 caregiver-child dyads: i) a control group ii) a growth charts only group; iii) a small quantity lipid-based nutrient supplements (SQ-LNS) only group; and iv) a growth charts + SQ-LNS group. Families in the growth charts groups (ii and iv) wi...