Effectiveness of SNF, Cash and BCC to Prevent Stunting Among Children 6-24 Months in Rahim Yar Khan, Pakistan
- Conditions
- Stunting
- Interventions
- Dietary Supplement: SNF (Wawamum)Other: CashBehavioral: Social and behaviour change communication (SBCC)
- Registration Number
- NCT03299218
- Lead Sponsor
- Aga Khan University
- Brief Summary
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.
- Detailed Description
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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 2179
- BISP beneficiary for intervention arms and poverty score between 16.18 - 20.00 according to the BISP approach for control group;
- Living in the catchment area of LHW;
- Have at least one child of 6-7 months old at the time of inclusion, and;
- Willing and able to provide written informed consent for the study.
- Non BISP households
- Planning to migrate form the study area in next 18 months
- Unable to provide written informed consent
- Children with severe malnutrition and/or chronic illness
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Cash with SNF (Wawamum) SNF (Wawamum) Cash-based transfers and SNF (Wawamum) Cash-based transfers Cash Cash-based transfers only by BISP Cash with SBCC Social and behaviour change communication (SBCC) Cash-based transfers and Social \& behaviour change communication (SBCC) Cash with SNF (Wawamum) Cash Cash-based transfers and SNF (Wawamum) Cash with SBCC Cash Cash-based transfers and Social \& behaviour change communication (SBCC) Cash,SNF (Wawamum) & SBCC Social and behaviour change communication (SBCC) Cash-based transfers, SNF (Wawamum) and SBCC Cash,SNF (Wawamum) & SBCC SNF (Wawamum) Cash-based transfers, SNF (Wawamum) and SBCC Cash,SNF (Wawamum) & SBCC Cash Cash-based transfers, SNF (Wawamum) and SBCC
- Primary Outcome Measures
Name Time Method Reduction in stunting 18 months 10% reduction in stunting in children
SBCC package on the basis of formative research 3 months SBCC package will be developed on the basis of formative research
Cost-effectiveness of intervention packages for prevention of stunting in children 18 months Cost effectiveness analysis will run through the full three years of the program cost
- Secondary Outcome Measures
Name Time Method Weight gain in kilograms 18 months Child weight in kilograms will be measured on monthly basis
Length gain in centimeters 18 months Child length in centimeters will be measured on monthly basis
Impact of the intervention on micronutrient deficiencies At 24 months of age Impact of the intervention on micronutrient deficiencies will be measured at 24 months by biochemical analysis
Improvement in IYCF practices 18 months Improvement in IYCF practices will be measured from monthly follow-up data
Improved nutrition, hygiene and health related knowledge and practices 18 months Improved nutrition, hygiene and health related knowledge and practices will be measured from endline KAP data
Proportion of households with moderate or severe hunger (food insecurity) 18 months Food insecurity will be measured from baseline and endline data
Uptake of health services and interventions 18 months Uptake of health services and interventions will be measured from baseline and endline data
Trial Locations
- Locations (1)
Tehsil Rahim Yar Khan
🇵🇰Rahim Yar Khan, Punjab, Pakistan