Money or Knowledge? Behavioral Aspects of Malnutrition

Not Applicable

Completed

• Conditions: Malnutrition

• Registration Number: NCT02903641
• Lead Sponsor: Harvard School of Public Health (HSPH)

Brief Summary

Malnutrition accounts for nearly half of child deaths worldwide. Children who are well-nourished are better able to learn in school, grow into more physically capable adults, and require less health care during childhood and adulthood. Moreover, it is difficult to make up for poor childhood nutrition later in life. I present here the proposal for an intervention that builds on a larger study in Ethiopia and will generate insights into the importance of behavioral factors related to persistent malnutrition in low-income settings, allowing for more targeted, cost-effective interventions in the future.

Existing data from the study region, Oromia, Ethiopia, suggest that many mothers know how to correctly respond to a hypothetical situation where a young child exhibits poor growth. On the other hand, however, mothers frequently appear unaware about their own children's growth deficiencies. Together, these facts suggest that false beliefs about the appropriateness of a child's physical size are a more likely contributor to malnutrition, rather than a weak understanding of how to help a malnourished child.

The proposed intervention will provide evidence on the relationship between caregiver beliefs about child nutritional status and the caregiver's behavior, ultimately analyzing how this relationship influences important nutritional choices for young children in a setting with limited resources. The study uses a two-by-two randomized trial; the first treatment is a cash transfer labeled for child food consumption, and the second is the provision of personalized information about the quality of the child's height compared to other children like those of the same age and gender in East Africa. Together the two treatment arms will provide evidence about the relative importance of behavioral versus resource barriers to improved nutrition. Better understanding of the interaction between these key factors is essential in addressing one of the foremost health issues facing developing countries today.

Detailed Description

Not available

Study Timeline

• Study Start: 2016-07
• Primary Completion: 2016-09
• Study Completion: 2016-09
• Study First Submitted: 2016-09-07
• Study First Submitted QC: 2016-09-12
• Study First Posted: 2016-09-16
• Status Verified: 2017-02
• Last Update Submitted: 2017-02-25
• Last Update Posted: 2017-02-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 506

Inclusion Criteria

• inclusion in the larger study required the household to have a child who was 6-35 months old for the main study's baseline survey in July-August 2015 (referred to as the index child) and for the household to have land for crop cultivation

Exclusion Criteria

• Households that did not meet the inclusion restriction or those who did not have anthropometric data collected during the larger study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Primary Outcome Measures

Name	Time	Method
Food frequency	6 weeks after baseline/intervention	Number of days in past week that index child consumed key foods (meat/fish, fruits, vegetables, eggs, milk/dairy products, legumes), as measured through an interview with the child's caregiver at 6 weeks post intervention
Dietary diversity	6 weeks after baseline/intervention	Number of foods that index child consumed in past 24 hours from among: grains, tubers, milk, vitamin-A rich fruits and vegetables (e.g., pumpkins, carrots, dark leafy vegetables, mangoes, papayas), other fruits and vegetables, animal protein foods, and legumes, as measured through an interview with the child's caregiver at 6 weeks post intervention
Meal frequency	6 weeks after baseline/intervention	Number of times child was fed in previous 24 hours; assessed separately depending on whether child is still breastfeeding, and by age group (\<24 months, 24-36 months, \>36 months), as measured through an interview with the child's caregiver at 6 weeks post intervention
Infant and child feeding index	6 weeks after baseline/intervention	Total score from: Dietary diversity (0 or 1 foods = 0 points, 2-3 foods = 1 point, 4+ foods=2 points), food frequency (0 days = 0 point, 1-3 days = 1 point, 4+ days = 2 points), breastfeeding (1 point; relevant for children up to 36 months), and meal frequency (0-1 meals = 0 points, 2 meals = 1 point, 3 meals = 2 points, 4+ meals = 3 points), as measured through an interview with the child's caregiver at 6 weeks post intervention
Household spending	6 weeks after baseline/intervention	Household spending on key foods (meat/fish, fruits and vegetables, eggs, milk/dairy products, legumes)

Secondary Outcome Measures

Name	Time	Method
Caregiver knowledge of how to improve child's growth	6 weeks after baseline/intervention
Caregiver perception of child's relative height	6 weeks after baseline/intervention
Caregiver satisfaction with child's height	6 weeks after baseline/intervention