Integrating MIYCN Counseling in Urban Health Services

NCT ID: NCT03882268

Last Updated: 2023-09-26

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 4128 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-11-15
• Study Completion Date: 2022-11-30

Brief Summary

The study will use a quasi-experimental design to examine the feasibility of standardizing MIYCN counseling services in existing health facilities to improve the quality of MIYCN services. The impact of standardized and upgraded services on client utilization, knowledge and behavior will also be measured. 8 NGO-run urban health facilities in Dhaka will receive intensified MIYCN interventions, while another 8 NGO-run urban health facilities will serve as a comparison group. No randomization will take place.

Detailed Description

The primary objectives of the proposed evaluation are to answer the following questions:

• Is it feasible to standardize the delivery of MIYCN counseling services in existing urban health facilities?
• Can quality of MIYCN counseling service be improved by upgrading and standardizing existing MIYCN counseling service in urban health facilities?
• What are the impacts of standardized and upgraded MIYCN counseling service on utilization of MIYCN services and knowledge of clients?

The secondary objectives are:

• What are the impacts of standardized and upgraded MIYCN counseling service on behaviors of clients including:

• Pregnant women: 1) consumption of diversified foods; 2) intake of IFA and calcium supplements during pregnancy
• Mothers of children <1 y: age-appropriate infant feeding

The study will use a quasi-experimental design, with data collection taking place in three different stages: 1) Baseline data collection to assess comparability of facilities, service quality and client's behaviors, 2) Facility-based endline data collection and 3) Community-based endline survey.

The evaluation was originally intended to be a randomized control trial, covering 20 NGO-run urban health facilities under contract with the Urban Primary Health Care Services Delivery Project (UPHCSDP). 10 of the 20 health facilities were randomized to receive the intervention, while the other 10 facilities would serve as the comparison group. Baseline data collection took place in these 20 facilities in October-November 2019. However, the project did not receive approval from UPHCSDP, and interventions were not implemented at the 10 facilities in the treatment group.

Instead, A&T partnered with 2 other NGOs in Dhaka whose 8 health facilities also provide services in urban areas but are not affiliated with UPHCSDP. These 8 facilities will receive the intervention. Propensity score matching will be used to select 8 of the original 20 facilities under contract with UPHCSDP to serve as the control group.

Baseline data collection in the intervention facilities will take place in February-March 2020. The facility-based end line will take place in May-June 2022, and the community-based endline will take place in June 2022. Data will be collected for the full sample of intervention facilities at baseline (i.e. with the same sample size as at endline), given uncertainty in obtaining government approval to collect endline data from comparison facilities under contract with UPHCSDP. The larger sample from intervention facilities at baseline allows for a shift in evaluation design from quasi-experimental to a pre-post comparison, if the project does not receive government approval.

The study will use mixed data collection methods including: 1) facility assessment; 2) provider survey; 3) case observations (namely ANC visits, child visits [both sick child and immunization], and counseling sessions), 4) client interviews and 5) in-depth interview with Program Managers and Field Supervisors.

Conditions

Maternal Nutrition

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

MIYCN interventions

8 facilities run by 2 NGOs that will receive intensified MIYCN interventions.

Group Type: EXPERIMENTAL

MIYCN interventions

Intervention Type: BEHAVIORAL

1. Capacity building for health providers and nutrition counselors (training on MIYCN SBCC from A&T).

2. Dedicated room for MIYCN counseling at health facilities with standardized layouts, displays of government IYCF logo, and other specifications.

3. Availability of standardized MIYCN-specific BCC materials and job aids.

4. Standardized MIYCN counseling services (counseling on diet diversity and quantity, IFA and calcium supplementation, weight gain monitoring, exclusive and early initiation of breastfeeding, complementary feeding, and water, sanitation and health) provided by a dedicated MIYCN counselor hired by A&T.

5. Dedicated community worker hired by A&T to identify and mobilize beneficiaries needing services in the community (via satellite clinic outreach, distribute MIYCN flyers, and provision of MIYCN education via phone or home visits).

6. Supportive supervision of MIYCN counselors and community workers by program and facility managers, and field supervisors.

Comparison facilities

8 facilities run by 2 other NGOs, which will not receive any standardized MIYCN interventions.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

MIYCN interventions

1. Capacity building for health providers and nutrition counselors (training on MIYCN SBCC from A&T).

2. Dedicated room for MIYCN counseling at health facilities with standardized layouts, displays of government IYCF logo, and other specifications.

3. Availability of standardized MIYCN-specific BCC materials and job aids.

4. Standardized MIYCN counseling services (counseling on diet diversity and quantity, IFA and calcium supplementation, weight gain monitoring, exclusive and early initiation of breastfeeding, complementary feeding, and water, sanitation and health) provided by a dedicated MIYCN counselor hired by A&T.

5. Dedicated community worker hired by A&T to identify and mobilize beneficiaries needing services in the community (via satellite clinic outreach, distribute MIYCN flyers, and provision of MIYCN education via phone or home visits).

6. Supportive supervision of MIYCN counselors and community workers by program and facility managers, and field supervisors.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Pregnant women who are visiting the health facilities for ANC visits (at least twice during her pregnancy, around half of clients)
• Mothers with children <12 months of age who are visiting the health facilities for health check-ups or vaccination

Exclusion Criteria

• Pregnant women with severe illness or complications
• Mothers with severely ill children

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 49 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: Yes

Sponsors

International Food Policy Research Institute

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Purnima Menon, PhD

Role: PRINCIPAL_INVESTIGATOR

IFPRI

Locations

Data Analysis and Technical Assistance Limited

Dhaka, , Bangladesh

Countries

Bangladesh

References

Nguyen PH, Sununtnasuk C, Christopher A, Ash D, Ireen S, Kabir R, Mahmud Z, Ali M, Forissier T, Escobar-DeMarco J, Frongillo EA, Menon P. Strengthening Nutrition Interventions during Antenatal Care Improved Maternal Dietary Diversity and Child Feeding Practices in Urban Bangladesh: Results of a Quasi-Experimental Evaluation Study. J Nutr. 2023 Oct;153(10):3068-3082. doi: 10.1016/j.tjnut.2023.06.023. Epub 2023 Jun 23.

Reference Type: DERIVED

PMID: 37354978 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

InternationalFPRI

Identifier Type: -

Identifier Source: org_study_id