Impact Evaluation of the DFID Programme to Accelerate Improved Nutrition of the Extreme Poor in Bangladesh
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 11,340
- 试验地点
- 1
- 主要终点
- Child anthropometry - weight for height
研究概览
简要总结
This is a randomized study in three areas of Bangladesh (Chars region where CLP operates, Haor region where Shiree operates, and urban slums where UPPR operates). Treatment is assigned at the community level, where treatments are:
- Livelihoods intervention only (L only)
- Livelihoods intervention plus nutrition intervention (L+N)
In UPPR only, the study also includes a non-randomly selected comparison group (C).
Within treatment localities, targeted beneficiaries include women, adolescent girls, and children under 24 months. Benefits are received for two years.
详细描述
Undernutrition is widespread in Bangladesh. In 2011, according to the Bangladesh Demographic and Health Survey, 41.3 per cent of children under age five were stunted, 36.4 per cent were underweight, 15.6 per cent were wasted, and more than 50 per cent were anaemic. Prevalences were even higher among extremely poor households. Meanwhile, evidence from South Asia shows that high rates of economic growth and reduction in poverty have not led to similarly large reductions in undernutrition (see 1, 2, 3). These findings have suggested that improvements in income alone may not be sufficient to improve nutritional status. Extensive research has also shown that the critical window for nutritional interventions is during the "first thousand days" of life (see 4, 5), from the time when a child is in utero until about two years of age. Based on this accumulated evidence, growing attention has come to introducing nutrition interventions that target children's "first thousand days" alongside household poverty reduction programmes. In particular, there has been growing emphasis on nutrition interventions that aim to improve infant and young child feeding practices-through increasing nutritional knowledge of women who are pregnant, lactating, or likely to be pregnant in the future-as well as to improve the nutritional status of these women themselves.
Although there exists considerable evidence assessing the effectiveness of various livelihoods interventions and other social protection programmes, as well as some evidence on the effectiveness of various direct nutritional interventions, little research directly assesses how an integrated livelihoods and nutrition programme might compare with livelihoods support alone. There are several reasons why the combination of nutrition and livelihoods support may have nutritional benefits over and above livelihoods support only. First, a key constraint to improved nutritional status may be insufficient knowledge of appropriate infant and young child feeding practices (for example, the appropriate duration of exclusive breastfeeding, the appropriate frequency and diversity of child feeding thereafter, etc.). If this is the case, then improving income alone will not necessarily lead to improved feeding practices. Second, there may be synergies between the two types of support. For example, even if a mother's knowledge of infant and young child feeding practices improves, she may still need access to sufficient resources for undertaking those practices (such as income to purchase the recommended types of food), which can be facilitated through a livelihoods intervention. Third, there may be other dynamics shifted through the direct nutrition intervention that mediate how the livelihoods intervention affects nutritional status. For example, if a direct nutrition intervention targeting women improves women's bargaining power within the household, and if women tend to prefer devoting more resources to young children's nutrition (e.g., Quisumbing and Maluccio 2003), the result may also be larger impacts on nutritional status than livelihoods support alone.
The DFID Programme to Accelerate Improved Nutrition for the Extreme Poor in Bangladesh aims to improve nutrition outcomes for young children, pregnant and lactating mothers, and adolescent girls. Its approach is to integrate direct nutrition interventions into the livelihood support currently provided to extremely poor households in Bangladesh through three existing programmes: the Chars Livelihoods Programme (CLP), the Shiree Economic Empowerment of the Poorest Programme (Shiree or EEP, within which the investigators focus on the Concern subproject), and the Urban Partnership for Poverty Reduction Programme (UPPR).
In order to rigorously and independently assess the impacts of these integrated nutrition and livelihoods programmes, DFID has collaborated with research partners and implementation partners to undertake a mixed methods impact evaluation, entitled "Impact Evaluation of the DFID Programme to Accelerate Improved Nutrition for the Extreme Poor in Bangladesh." The evaluation team includes IDS (the lead organisation), IFPRI, ITAD, CNRS, and BRAC University. The evaluation uses mixed quantitative and qualitative methods within a strong theory-based design to assess the impacts of the integrated programmes on nutritional status.
The quantitative impact component involves a baseline survey (conducted in September-November 2013) and an endline survey (to be conducted in November-December 2015). The exploratory/explanatory component includes a qualitative subcomponent (for which the first phase of fieldwork has been ongoing since February 2014), as well as a process evaluation subcomponent (ongoing since July 2014, final results not yet available). The cost effectiveness component began in August 2014 and will be completed in early 2016 following the quantitative endline survey completion.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Basic Science
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Children (boys and girls) 0-36 months
- •Pregnant and breastfeeding women
- •Adolescent girls (aged 13-19)
- •Households must meet eligibility criteria of each of the three programmes (CLP, Shiree, UPPR) except for the control group in UPPR.
排除标准
- 未提供
研究组 & 干预措施
CLP: Livelihoods plus nutrition
Livelihoods programmes offered by CLP, plus nutrition programmes offered by CLP.
干预措施: CLP: Livelihoods (Behavioral)
CLP: Livelihoods plus nutrition
Livelihoods programmes offered by CLP, plus nutrition programmes offered by CLP.
干预措施: CLP: Nutrition (Dietary Supplement)
Shiree: Livelihoods only
Livelihoods programmes offered by Shiree.
干预措施: Shiree: Livelihoods (Behavioral)
Shiree: Livelihoods plus nutrition
Livelihoods programmes offered by Shiree, plus nutrition programmes offered by Shiree.
干预措施: Shiree: Livelihoods (Behavioral)
UPPR: Control
No interventions are provided.
干预措施: UPPR: Control (Other)
UPPR: Livelihoods only
Livelihoods programmes offered by UPPR.
干预措施: UPPR: Livelihoods (Behavioral)
UPPR: Livelihoods plus nutrition
Livelihoods programmes offered by UPPR, plus nutrition programmes offered by UPPR.
干预措施: UPPR: Livelihoods (Behavioral)
UPPR: Livelihoods plus nutrition
Livelihoods programmes offered by UPPR, plus nutrition programmes offered by UPPR.
干预措施: UPPR: Nutrition (Dietary Supplement)
CLP: Livelihoods only
Livelihoods programmes offered by CLP.
干预措施: CLP: Livelihoods (Behavioral)
Shiree: Livelihoods plus nutrition
Livelihoods programmes offered by Shiree, plus nutrition programmes offered by Shiree.
干预措施: Shiree: Nutrition (Dietary Supplement)
结局指标
主要结局
Child anthropometry - weight for height
时间窗: Baseline. Up to 24 months.
Weight for height z scores. Outcomes specified in terms of levels two years after intervention started, as well as in changes (2013-2015).
Dietary diversity of index child's mother, father, and of adolescent girl
时间窗: Baseline. Up to 24 months.
Number of food groups consumed in previous 24 hours. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Infant and young child feeding practices - complementary feeding
时间窗: Baseline. Up to 24 months.
Age complementary feeding initiated. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Child food intake - number unique foods
时间窗: Baseline. Up to 24 months.
Number of unique foods consumed in previous 24 hours. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Household food security - unique foods
时间窗: Baseline. Up to 24 months.
Number of unique foods consumed in previous seven days. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Household food security - caloric availability
时间窗: Baseline. Up to 24 months.
Household caloric availability in previous seven days. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Child anthropometry - height for age
时间窗: Baseline. Up to 24 months.
Height for age z scores. Outcomes specified in terms of levels two years after intervention started, as well as in changes (2013-2015).
Infant and young child feeding practices - breastfeeding
时间窗: Baseline. Up to 24 months.
Length of breastfeeding of index child. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Child anthropometry - stunting
时间窗: Baseline. Up to 24 months.
Percentage of children 0-24 stunted. Outcomes specified in terms of levels two years after intervention started, as well as in changes (2013-2015).
Child anthropometry - wasting
时间窗: Baseline. Up to 24 months.
Percentage of children 0-24 wasted. Outcomes specified in terms of levels two years after intervention started, as well as in changes (2013-2015).
Community nutrition worker knowledge and activities
时间窗: Up to 24 months.
Number of home visits and group training sessions in past month. Outcomes specified in terms of levels two years after intervention started.
Receipt of and participation in livelihoods and nutrition interventions (take up)
时间窗: Baseline. Up to 24 months.
Whether received livelihoods and nutrition interventions carried out by CLP/Shiree/UPPR programmes. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Child food intake - caloric consumption
时间窗: Baseline. Up to 24 months.
Caloric consumption in previous 24 hours. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Household food security - food groups
时间窗: Baseline. Up to 24 months.
Food groups consumed by household in previous seven days. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Child food intake - number food groups
时间窗: Baseline. Up to 24 months.
Number of food groups consumed in previous 24 hours. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Household food security - value of consumption
时间窗: Baseline. Up to 24 months.
Value of food consumption in previous seven days. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Dietary diversity of index child's mother, father, and of adolescent girl - unique foods
时间窗: Baseline. Up to 24 months.
Number of unique foods consumed in previous 24 hours. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Index child mother's nutrition knowledge
时间窗: Baseline. Up to 24 months.
Knowledge (total score) of index child's mother regarding questions on breastfeeding, complementary feeding, nutrition, and sanitation practices (29 questions). Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Community nutrition worker knowledge and activities.
时间窗: Up to 24 months.
Misconceptions regarding nutrition knowledge and attitudes (regarding breastfeeding, complementary feeding, and sanitation knowledge). Outcomes specified in terms of levels two years after intervention started.
Child anthropometry - weight for age
时间窗: Baseline. Up to 24 months.
Weight for age z scores. Outcomes specified in terms of levels two years after intervention started, as well as in changes (2013-2015).
Child food intake - food groups
时间窗: Baseline. Up to 24 months
Consumption of specific food groups (animal source foods, dairy, vitamin A rich foods, etc.) in previous 24 hours. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Household food security - number of food groups
时间窗: Baseline. Up to 24 months.
Number of food groups consumed in previous seven days weighted by nutritional value and frequency of consumption. Outcomes specified in terms of levels two years after intervention started, and as changes (2013-2015).
Women's BMI
时间窗: Baseline. Up to 24 months.
Body mass index of index child's mother. Weight for height z scores. Outcomes specified in terms of levels two years after intervention started, as well as in changes (2013-2015).
次要结局
- Ownership of assets - value(Baseline. Up to 24 months.)
- Health of index child <36 months - care sought(Baseline. Up to 24 months.)
- Health of index child <36 months - child ill(Baseline. Up to 24 months.)
- Household income(Baseline. Up to 24 months.)
- Health of index child < 36 months - where care received(Baseline. Up to 24 months.)
- Antenatal care(Baseline. Up to 24 months.)
- Care at birth(Baseline. Up to 24 months.)
- Household consumption - food and non-food(Baseline. Up to 24 months.)
- Antenatal care - attendance(Baseline. Up to 24 months.)
- Nutrition knowledge of adolescent girl(Baseline. Up to 24 months.)
- Women's status index(Baseline. Up to 24 months.)
- Household consumption - food consumption(Baseline. Up to 24 months.)
- Housing quality(Baseline. Up to 24 months.)
- Sanitation practices for index child(Baseline. Up to 24 months.)
- Household consumption - value of non-food consumption(Baseline. Up to 24 months.)
- Household consumption - value of non-food consumption subgroups(Baseline. Up to 24 months.)