Effectiveness of SNF and SBCC to Prevent Stunting Among Children in Afghanistan: a Quasi-experimental Study

NCT ID: NCT04581993

Last Updated: 2023-08-16

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 33100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-02-01
• Study Completion Date: 2022-12-31

Brief Summary

Over the years, there has been some progress made in reducing stunting in Afghanistan, the prevalence remains high with half of the provinces experiencing rates above the WHO alert threshold. As part of the Country Strategic Plan (CSP), the World Food Programme (WFP) plans to implement a stunting prevention programme in collaboration with Ministry of Public Health (MoPH) through its Public Nutrition Department (PND) in selected locations with stunting rates above 45%. The programme will emphasis on appropriate nutrition support in the '1000 days' window of opportunity with special focus on proven effective nutrition interventions such appropriate breast feeding, complementary feeding, micronutrient supplementation, malnutrition treatment and prevention, WASH.

Detailed Description

Over the years, there has been some progress made in reducing stunting in Afghanistan, the prevalence remains high with half of the provinces experiencing rates above the WHO alert threshold. As part of the Country Strategic Plan (CSP), the World Food Programme (WFP) plans to implement a stunting prevention programme in collaboration with Ministry of Public Health (MoPH) through its Public Nutrition Department (PND) in selected locations with stunting rates above 45%. The programme will emphasis on appropriate nutrition support in the '1000 days' window of opportunity with special focus on proven effective nutrition interventions such appropriate breast feeding, complementary feeding, micronutrient supplementation, malnutrition treatment and prevention, WASH. This will therefore take the form of an integrated approach ensuring the targeted beneficiaries are supported to access nutrition assistance as well as other complimentary interventions provided in-kind by study partners or promoted through social and behaviour change communication (SBCC). WFP will target pregnant and lactating women (PLW) and children aged 6-23 months but will also engage men and players that influence maternal infant and young child nutrition practices. Through this programme, children aged 6-23 months will receive lipid-based nutrient supplement - medium quantity (LNS-MQ) to complement their diets while PLW will receive Super Cereal - wheat soya blend with sugar.

An operational research study was embedded in the stunting prevention programme by credible third-party to determine the extent to which the new actions will influence nutrition outcomes and practices. Introducing the provision of SNF, SBCC as well as formulation and adoption of local culturally acceptable recipes for complementary feeding from locally available nutritious food would be new additions to the current Community Based Nutrition Program (CBNP) package in the implementation phase. During the project implementation, emphasis will be placed will be placed on the adoption of the locally formulated complementary foods as well as application of knowledge and practices promoted through the SBCC activities as part of the exit strategy and ensuring a lasting impact of the project.

Therefore, the Centre of Excellence in Women and Child Health, Aga Khan University, Pakistan proposes an operational research study with mix-methods including formative research, quasi-experimental design to evaluate the stunting prevention programme and process evaluations for stronger evidence base on the effectiveness of proposed interventions on prevention of stunting and developing viable programmes on nutrition under "real" operational conditions.

Conditions

Stunting; Malnutrition, Child

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: SINGLE

Study Groups

Intervention

Pregnant and lactating women (PLW) will receive Super Cereal - wheat soya blend with sugar and children aged 6-23 months will receive lipid-based nutrient supplement-medium quantity (LNS-MQ). Social and behavior change communication (SBCC), community mobilization, referrals, identification of model families, food demonstrations, local recipe) ration/beneficiary entitlement cards will be provided for easy verification and tracking during delivery of intervention.

Group Type: EXPERIMENTAL

Super Cereal - wheat soya blend with sugar

Intervention Type: DIETARY_SUPPLEMENT

Pregnant and lactating women will received Super Cereal during pregnancy and first six months of lactation.

Lipid-based nutrient supplement-medium quantity (LNS-MQ)

Intervention Type: DIETARY_SUPPLEMENT

Children will receive LNS during 6-23 months of age.

Social and behavior change communication (SBCC)

Intervention Type: BEHAVIORAL

SBCC will be provided to improve care-givers knowledge, attitudes and practices related to infant and young child feeding.

Control

Control districts will receive routine health care services available in the study area.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Super Cereal - wheat soya blend with sugar

Pregnant and lactating women will received Super Cereal during pregnancy and first six months of lactation.

Intervention Type: DIETARY_SUPPLEMENT

Lipid-based nutrient supplement-medium quantity (LNS-MQ)

Children will receive LNS during 6-23 months of age.

Intervention Type: DIETARY_SUPPLEMENT

Social and behavior change communication (SBCC)

SBCC will be provided to improve care-givers knowledge, attitudes and practices related to infant and young child feeding.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Pregnant and lactating women
• Children 6-23 months
• Willing to participate

Exclusion Criteria

• Non pregnant and lactating women
• Children >24 months
• Refuse to participate

• Minimum Eligible Age: 6 Months
• Maximum Eligible Age: 49 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Ministry of public Health Afghanistan

UNKNOWN

Sponsor Role: collaborator

United Nations World Food Programme (WFP)

OTHER

Sponsor Role: collaborator

The Aga Khan Foundation

OTHER

Sponsor Role: collaborator

Aga Khan Health Services

OTHER

Sponsor Role: collaborator

Aga Khan University

OTHER

Sponsor Role: lead

Responsible Party

Dr Sajid Bashir Soofi

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Sajid B Soofi, MBBS, FCPS

Role: PRINCIPAL_INVESTIGATOR

Aga Khan University

Locations

Aga Khan Health Services

Fayzabad, Badakhshān, Afghanistan

Countries

Afghanistan

References

Soofi SB, Khan GN, Sajid M, Hussainyar MA, Shams S, Shaikh M, Ouma C, Azami S, Naeemi M, Hussain A, Umer M, Hussain I, Ahmed I, Ariff S. Specialized nutritious foods and behavior change communication interventions during the first 1000 d of life to prevent stunting: a quasi-experimental study in Afghanistan. Am J Clin Nutr. 2024 Sep;120(3):560-569. doi: 10.1016/j.ajcnut.2024.07.007. Epub 2024 Jul 14.

Reference Type: DERIVED

PMID: 39004283 (View on PubMed)

Other Identifiers

Stunting Study Afghanistan

Identifier Type: -

Identifier Source: org_study_id