Strategies to Increase Milk Consumption by Young Nepali Children
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 368
- 试验地点
- 1
- 主要终点
- Change in child weight from baseline to midline
研究概览
简要总结
Dairy animals are an important source of income, food and nutrition security at the household level. However, substandard animal husbandry practices and limited understanding of disease prevention and control may limit dairy animal productivity. Interventions to address these issues may enhance milk production, substantially improving the well-being of smallholder farmers. In addition to increasing household income, greater milk production may improve the diet quality of household members, particularly children.
Previously, the investigators implemented a program in rural Nepal promoting enhanced animal husbandry practices (GHP), focusing on mastitis control. Concurrently, the investigators found child milk intake was strongly linked to better growth and development. However, milk intake was limited and its availability was not examined. The investigators now propose to build on these prior activities and examine strategies to increase child milk consumption. The investigators plan to introduce a nutrition education program into 200 households (with young children) which previously received GHP training. A comparison group of 200 households will serve as the control. Household surveys will be conducted at baseline and endline to assess (1) household milk production and the sustainability of adoption of GHP routines, (2) the relationship of household milk production to child milk consumption, (3) household factors influencing child milk consumption (participation in nutrition education, mother's education, socioeconomic status, etc.), and (4) longitudinal child growth and development. In addition, a pilot study will determine if households can accurately record milk production and child milk intake.
The project is designed to enhance understanding of the links between milk availability and child milk consumption in rural Nepal. It aims to explore whether milk consumption is limited by availability or other factors (nutrition awareness, socioeconomic status, maternal education). Additionally, the investigators will examine if optimization of milk consumption by young children can further boost their growth and development, and whether instruction in good animal husbandry practice and mastitis control is sustainable. These findings could more appropriately and efficiently direct resources to improve child nutrition and development and household dairy practices.
详细描述
The study will be conducted in close collaboration with Heifer International Nepal, a well-established branch of Heifer International, an international non-government organization based in Little Rock, Arkansas. Heifer specializes in community development activities and livestock management training; as part of Heifer's activities, participating households receive 1 or more dairy animals. The proposed study will take place in 3 districts in western Nepal (Bardiya, Surkhet, and Dang) where Heifer has been active and dairy animals have been distributed. Households (n=400) will be eligible for participation if there is at least one child between the ages of 6-66 months and at least one dairy animal. Household clusters (separated geographically) will be randomly assigned to receive either nutrition education or to control status (no education). Households assigned to control status will be offered the nutrition education after completion of data collection for the proposed project (12 months later).
The participants will be one adult in each household (usually the child's mother), and any children in the household between the ages of 6-66 months.
The study design involves 3 household visits, spaced over 12 months (thus: baseline, 6 months, and endline). In addition, information about household dairy animal milk production will be collected on a monthly basis.
At the baseline and endline household visits, the mother (or other caretaker) of the target child will be asked to respond to a questionnaire. The questionnaire will be based on standardized tools developed by "Measure Demographic and Health survey (DHS)", specifically the version used in the "2016 Nepal Demographic and Health Survey" conducted by the Government of Nepal (Ministry of Health et al. 2017) (Ministry of Health and Population Nepal et al. 2012). The questionnaire will address (A) household attributes, (B) child diet, (C) child growth, and (D) child development.
(A) Household attributes: basic demographics, possessions (used to determine wealth score by standard principal components analysis), hygiene practices, animal ownership, mother's knowledge/attitudes/practices related to child nutrition.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 6 Months 至 66 Months（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •6-66 months of age, parent willing to participate in research activity
排除标准
- •unwillingness to participate in the research activity, plans to leave the area within the next 12 months, or child with physical or other special needs that prevent the ingestion of a normal diet-for-age.
结局指标
主要结局
Change in child weight from baseline to midline
时间窗: baseline, midline (0, 6 months)
Weight of children will be measured, and converted to z scores. The difference from baseline to midline will be assessed.
Change in child weight from baseline to endline
时间窗: baseline, endline (0, 12 months)
Weight of children will be measured, and converted to z scores. The difference from baseline to midline will be assessed.
Change in child height from baseline to midline
时间窗: baseline, midline (0, 6 months)
Height of children will be measured, and converted to z scores. The difference from baseline to midline will be assessed.
Change in child height from baseline to endline
时间窗: baseline, endline (0, 12 months)
Height of children will be measured, and converted to z scores. The difference from baseline to endline will be assessed.
Change in child development standardized score from baseline to endline
时间窗: baseline and endline (0, 12 months)
Developmental performance on standardized test, the Ages and Stages Questionnaire. The change in scores from baseline to endline will be assessed.
Change in child head circumference from baseline to midline
时间窗: baseline, midline (0, 6 months)
Head circumference will be measured, and converted to z scores
Change in child head circumference from baseline to endline
时间窗: baseline, endline (0, 12 months)
Head circumference will be measured, and converted to z scores
次要结局
- Milk consumption by children(daily for up to 365 days)
研究者
Laurie Miller, MD
Professor of Pediatrics
Tufts University