Effectiveness of SNF, Cash and BCC to Prevent Stunting Among Children 6-24 Months in Rahim Yar Khan, Pakistan

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2179 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-26

Study Completion Date

2019-07-31

Brief Summary

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Malnutrition is a public health problem, with long-lasting physiological consequences and increased risk of morbidity and mortality. It can be recognized as one of the key obstacles in national development, due to its influence on individual productivity, school performance and physical work capacity. Malnutrition is a hidden crisis in Pakistan, with rates increasing during the last decade. High prevalence of food insecurity, illiteracy, lack of nutritional knowledge, poor hygiene status, and under recognized role of nutrition are some of the possible causes. The situation of malnutrition in Pakistan necessitates an urgent need for addressing its causes through various nutrition interventions, in order to ensure a bright future for the coming generations.

Although, malnutrition is a major problem across Pakistan, its burden and implications in the remote districts of Punjab are quite evident. The levels of undernutrition in district Rahim Yar Khan are high, with 47% of children being underweight. These numbers also highlight the presence of long-term undernutrition in the district, as evidenced by 45% of the children being stunted in 2014.

Given the alarming situation of child malnutrition in district Rahim Yar Khan, the World Food Program (WFP) Pakistan is proposing an intervention program comprised of cash-based transfers, specialized nutritious foods and behaviours change communication to prevent stunting in district Rahim Yar Khan, province Punjab. The interventions will be delivered through the existing health system and Benazir Income Support Programme (BISP). It is anticipated that the intervention will reduce the widespread macro and micro nutrient malnutrition and food insecurity in the targeted areas. Furthermore, to ensure the presence of adequate evidence to persuade policymakers for further scaling up, it is essential that an impact evaluation be conducted. Therefore, the Department of Paediatrics and Child Health, Aga Khan University (AKU) using robust methodologies on a representative sample size in the district of Rahim Yar Khan to assess the effectiveness of the WFP interventions on process and outcome indicators.

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Detailed Description

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Malnutrition is a public health problem, with long-lasting physiological consequences and increased risk of morbidity and mortality. It can be recognized as one of the key obstacles in national development, due to its influence on individual productivity, school performance and physical work capacity. Malnutrition is a hidden crisis in Pakistan, with rates increasing during the last decade. High prevalence of food insecurity, illiteracy, lack of nutritional knowledge, poor hygiene status, and under recognized role of nutrition are some of the possible causes. The situation of malnutrition in Pakistan necessitates an urgent need for addressing its causes through various nutrition interventions, in order to ensure a bright future for the coming generations.

The second Lancet Series on Maternal and Child Under-nutrition (2013) and the Scaling-Up Nutrition (SUN) Initiative give some recommendations on selected effective approaches for the management and prevention of under-nutrition, such as breastfeeding counselling or micronutrient supplementation, but evidence gaps still remain, particularly concerning indirect interventions. The World Health Organization highlighted in 2010 the need to consider prevention strategies when implementing programs aiming at reducing stunting rates. There is also evidence showing that preventive programs, such as supplementation, can be more effective to reduce childhood under-nutrition than nutrition rehabilitation. Reviews on cash transfer experiences show that this type of intervention has the potential to prevent undernutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to inconclusive evidence regarding their nutritional benefits.

Although, malnutrition is a major problem across Pakistan, its burden and implications in the remote districts of Punjab are especially evident. The levels of undernutrition in district Rahim Yar Khan are high, with 47% of children being underweight. These numbers also highlight the presence of long-term undernutrition in the district, as evidenced by 45% of the children being stunted in 2014.

Given the alarming situation of child malnutrition in Rahim Yar Khan district, the World Food Programme (WFP) Pakistan is proposing an intervention programme comprised of cash-based transfers, specialized nutritious foods and behavior change communication to prevent stunting in Rahim Yar Khan district, Punjab province. The interventions will be delivered through the existing health system and the social protection programme, Benazir Income Support Programme (BISP). It is anticipated that the intervention will reduce the widespread macro and micro nutrient malnutrition and food insecurity in the targeted areas. Furthermore, to ensure the presence of adequate evidence to persuade policymakers for further scaling up, it is essential that an impact evaluation be conducted. The study will be conducted by the Aga Khan University (AKU) using robust methodologies on a representative sample size in the district of Rahim Yar Khan. This document will describe the methods and strategies that AKU will employ to assess the effectiveness of the interventions on process and outcome indicators.

Conditions

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Stunting

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

1. Control Group
2. Cash-based transfers only by BISP
3. Cash-based transfers and Social \& behaviour change communication (SBCC)
4. Cash-based transfer and SNF
5. Cash-based transfers, SNF and SBCC

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Control

Receiving current Government of Punjab health services

Group Type NO_INTERVENTION

No interventions assigned to this group

Cash-based transfers

Cash-based transfers only by BISP

Group Type EXPERIMENTAL

Cash

Intervention Type OTHER

Cash totaling 1600 rupees per month will be transferred by BISP throughout the study period.

Cash with SBCC

Cash-based transfers and Social \& behaviour change communication (SBCC)

Group Type EXPERIMENTAL

Social and behaviour change communication (SBCC)

Intervention Type BEHAVIORAL

SBCC messages will be delivered by LHWs in their monthly routine household visits. Male and female group sessions will be arranged on quarterly basis with the help of health committees.

Cash

Intervention Type OTHER

Cash totaling 1600 rupees per month will be transferred by BISP throughout the study period.

Cash with SNF (Wawamum)

Cash-based transfers and SNF (Wawamum)

Group Type EXPERIMENTAL

SNF (Wawamum)

Intervention Type DIETARY_SUPPLEMENT

A monthly ration of 30 sachets of SNF (one 50 gram sachet of Wawamum per child per day) will be provided by LHWs. Each recruited child will receive SNF on a monthly basis for the duration of 18 months during his/her age of 6-24 months.

Cash

Intervention Type OTHER

Cash totaling 1600 rupees per month will be transferred by BISP throughout the study period.

Cash,SNF (Wawamum) & SBCC

Cash-based transfers, SNF (Wawamum) and SBCC

Group Type EXPERIMENTAL

SNF (Wawamum)

Intervention Type DIETARY_SUPPLEMENT

A monthly ration of 30 sachets of SNF (one 50 gram sachet of Wawamum per child per day) will be provided by LHWs. Each recruited child will receive SNF on a monthly basis for the duration of 18 months during his/her age of 6-24 months.

Social and behaviour change communication (SBCC)

Intervention Type BEHAVIORAL

SBCC messages will be delivered by LHWs in their monthly routine household visits. Male and female group sessions will be arranged on quarterly basis with the help of health committees.

Cash

Intervention Type OTHER

Cash totaling 1600 rupees per month will be transferred by BISP throughout the study period.

Interventions

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SNF (Wawamum)

A monthly ration of 30 sachets of SNF (one 50 gram sachet of Wawamum per child per day) will be provided by LHWs. Each recruited child will receive SNF on a monthly basis for the duration of 18 months during his/her age of 6-24 months.

Intervention Type DIETARY_SUPPLEMENT

Social and behaviour change communication (SBCC)

SBCC messages will be delivered by LHWs in their monthly routine household visits. Male and female group sessions will be arranged on quarterly basis with the help of health committees.

Intervention Type BEHAVIORAL

Cash

Cash totaling 1600 rupees per month will be transferred by BISP throughout the study period.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. BISP beneficiary for intervention arms and poverty score between 16.18 - 20.00 according to the BISP approach for control group;
2. Living in the catchment area of LHW;
3. Have at least one child of 6-7 months old at the time of inclusion, and;
4. Willing and able to provide written informed consent for the study.

Exclusion Criteria

1. Non BISP households
2. Planning to migrate form the study area in next 18 months
3. Unable to provide written informed consent
4. Children with severe malnutrition and/or chronic illness

Minimum Eligible Age

6 Months

Maximum Eligible Age

7 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes