Evaluation of REACTS-IN, an Intervention to Improve Nutrition, Hygiene, and Sexual and Reproductive Health Services
- Conditions
- StuntingDiet; DeficiencyGender EqualityAcceptability of Health CareEmpowerment
- Interventions
- Behavioral: Education intervention on nutrition, gender equity, WASH, sexual and reproductive health rightsDietary Supplement: school-based iron-folic acid supplement programBehavioral: Health service training on equitable access to nutrition, health, and sexual and reproductive servicesDietary Supplement: bio-fortified crops
- Registration Number
- NCT06362837
- Lead Sponsor
- McGill University
- Brief Summary
This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. The evaluation will collect baseline, midline, and end-line data from intervention and comparison communities, schools, and health facilities. The evaluation objectives are to test if the intervention improved indicators for (i) child anthropometry, (ii) maternal and child dietary practices, (iii) women's empowerment, and (iv) equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators.
- Detailed Description
This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention ("Realizing Gender Equality, Attitudinal Change and Transformative Systems in Nutrition", REACTS-IN) to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. REACTS-IN is a multi-sectoral approach, integrating nutrition-related determinants, such as water, sanitation, and hygiene (WASH) interventions and health systems strengthening, to improve access to quality and gender-responsive health systems with increased capacity to prevent and treat malnutrition, especially at the primary health care level. REACTS-IN includes both nutrition-specific (e.g., school-based iron-folic acid supplement program) and nutrition-sensitive (e.g., WASH education) activities delivered through local health systems and/or schools, and communities.
This independent evaluation will include three data collection at baseline, midpoint, and end-line to evaluate the performance indicators for the ultimate and intermediate outcomes. This includes indicators for child anthropometry, maternal and child dietary practices, women's empowerment, and equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators.
The data collection will be carried out with intervention communities as well as with comparison communities. The estimated household sample is 463 households (women, husbands, child)/arm/country per time point, selected through a multi-stage cluster sampling methodology. The household baseline survey with a representative sample of mothers with children (0-5.9 mo; 6-23.9 mo; 24-59.9 mo) will be compared to the values at midpoint (to assess initial impact and the need for program adjustments) and at end-line (to assess the total impact of the project). The surveys will include sociodemographic, economic, and environmental information to assess the indicators for the local context. The evaluation also includes a sample of 500 school-going adolescents (250 boys, 250 girls)/arm/country per time point to assess indicators of knowledge about nutrition, menstrual hygiene management, and sexual and reproductive health. Finally, a sample of approximately 24 health staff and community leaders will provide qualitative data on gender-equitable access to services per arm/country for baseline and end-line.
Although the project also is working in Somalia, this independent evaluation does not include data collection in Somalia.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 13500
(i)Women:
- 15-49 y of age
- biological mother of child in the home who is 0-5.9, 6-23.9, or 24-59.9 months
- has lived in the community for at 12 months
(ii) Husbands/partners:
- no age limit
- lives in the home with index woman
- has lived in community for at least 12 months
(iii) Adolescents:
- 10-19 years
- male or female
- has been in target school for at least 6 months
- lives in the target community
(iv) Children:
- 0-5.9, 6-23.9, or 24-59.9 months
(i) Children:
- no limitation on normal diet or growth (birth defects, illnesses)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Education intervention on nutrition, gender equity, WASH, sexual and reproductive health rights Includes multiple activities, depending on country, including support of school-based iron-folic acid supplementation program; promotion of bio-fortified crops (sweet potatoes, beans, rice, corn); training on nutrition, water \& sanitation, gender equity for rural communities through community groups and for health facility staff; support to improve gender-sensitive health services for nutrition, sexual and reproductive health, Intervention school-based iron-folic acid supplement program Includes multiple activities, depending on country, including support of school-based iron-folic acid supplementation program; promotion of bio-fortified crops (sweet potatoes, beans, rice, corn); training on nutrition, water \& sanitation, gender equity for rural communities through community groups and for health facility staff; support to improve gender-sensitive health services for nutrition, sexual and reproductive health, Intervention Health service training on equitable access to nutrition, health, and sexual and reproductive services Includes multiple activities, depending on country, including support of school-based iron-folic acid supplementation program; promotion of bio-fortified crops (sweet potatoes, beans, rice, corn); training on nutrition, water \& sanitation, gender equity for rural communities through community groups and for health facility staff; support to improve gender-sensitive health services for nutrition, sexual and reproductive health, Intervention bio-fortified crops Includes multiple activities, depending on country, including support of school-based iron-folic acid supplementation program; promotion of bio-fortified crops (sweet potatoes, beans, rice, corn); training on nutrition, water \& sanitation, gender equity for rural communities through community groups and for health facility staff; support to improve gender-sensitive health services for nutrition, sexual and reproductive health,
- Primary Outcome Measures
Name Time Method Gender equality Change between baseline and study completion, an average of 5 years Percent of households with children \< 59.9 mo that have achieved gender equality
Child anthropometry Change between baseline and study completion, an average of 5 years Percent of children 6-59 mo of age who are stunted
- Secondary Outcome Measures
Name Time Method Antenatal care Change between baseline and study completion, an average of 5 years Percent of mothers of children 0-6 months who attended at least four ante-natal visits during the last pregnancy from skilled health personnel
Contraception use by women and partners Change between baseline and study completion, an average of 5 years Percent of women aged 15-49 years married or in union, who are currently using, or whose sexual partner is using at least one modern contraception method
Child diet Change between baseline and study completion, an average of 5 years Percent of children 6-23.9 months of age, who receive minimum dietary diversity and minimum meal frequency
Sexual and reproductive health services for adolescents Change between baseline and study completion, an average of 5 years Percent of adolescent girls (10-19) who report that they were offered sexual and reproductive health services
Gender equitable health services for nutrition, health, and sexual and reproductive health Change between baseline and study completion, an average of 5 years Percent of health facilities promoting gender equitable and responsive nutrition, health, and sexual and reproductive services
Exclusive breastfeeding Change between baseline and study completion, an average of 5 years Percent of children 0-5.9 mo who are exclusively breastfed
Use of family planning Change between baseline and study completion, an average of 5 years Percent of women 15-49 y who decided to use family planning
adolescent knowledge of nutrition, menstrual hygiene, and sexual and reproductive health Change between baseline and study completion, an average of 5 years Percent of adolescent girls and boys with appropriate knowledge about nutrition, menstrual hygiene, and sexual and reproductive health
maternal knowledge on nutrition Change between baseline and study completion, an average of 5 years Percent of women 15-49 y with appropriate knowledge on good maternal nutrition
Attended birth deliveries Change between baseline and study completion, an average of 5 years Percent of deliveries attended by skilled birth personnel
maternal knowledge of family planning Change between baseline and study completion, an average of 5 years Percent of mothers who know at least 3 modern methods of family planning
maternal knowledge of exclusive breastfeeding Change between baseline and study completion, an average of 5 years Percent of mothers who know at least 3 benefits of exclusive breastfeeding
mothers planting biofortified crops Change between baseline and study completion, an average of 5 years Percent of mothers who have planted biofortified crops from REACTS-IN materials
mothers planting nutrient dense local vegetables Change between baseline and study completion, an average of 5 years Percent of mothers who have planted nutrient dense local vegetables from REACTS-IN seeds
mothers planting trees Change between baseline and study completion, an average of 5 years Percent of mothers who have planted fruit tress from REACTS-IN materials
hygenic toilets Change between baseline and study completion, an average of 5 years Percent of households with hygienic toilets
community health worker visit Change between baseline and study completion, an average of 5 years Percent of households that received at least one community health worker visit in last month
Adolescent iron folic acid supplements Change between baseline and study completion, an average of 5 years Percent of adolescent girls who received the recommended scheme of weekly iron-folic actic supplements
health facility Change between baseline and study completion, an average of 5 years Percent of health facilities scoring \> 80 on planning assessment
Trial Locations
- Locations (3)
Brac University
🇧🇩Dhaka, Bangladesh
Connar Consultants
🇰🇪Nairobi, Kenya
Ifakara Health Institute
🇹🇿Ifakara, Tanzania