Integrating MIYCN Counseling in Urban Health Services
- Conditions
- Maternal Nutrition
- Interventions
- Behavioral: MIYCN interventions
- Registration Number
- NCT03882268
- Lead Sponsor
- International Food Policy Research Institute
- Brief Summary
The study will use a quasi-experimental design to examine the feasibility of standardizing MIYCN counseling services in existing health facilities to improve the quality of MIYCN services. The impact of standardized and upgraded services on client utilization, knowledge and behavior will also be measured. 8 NGO-run urban health facilities in Dhaka will receive intensified MIYCN interventions, while another 8 NGO-run urban health facilities will serve as a comparison group. No randomization will take place.
- Detailed Description
The primary objectives of the proposed evaluation are to answer the following questions:
* Is it feasible to standardize the delivery of MIYCN counseling services in existing urban health facilities?
* Can quality of MIYCN counseling service be improved by upgrading and standardizing existing MIYCN counseling service in urban health facilities?
* What are the impacts of standardized and upgraded MIYCN counseling service on utilization of MIYCN services and knowledge of clients?
The secondary objectives are:
* What are the impacts of standardized and upgraded MIYCN counseling service on behaviors of clients including:
* Pregnant women: 1) consumption of diversified foods; 2) intake of IFA and calcium supplements during pregnancy
* Mothers of children \<1 y: age-appropriate infant feeding
The study will use a quasi-experimental design, with data collection taking place in three different stages: 1) Baseline data collection to assess comparability of facilities, service quality and client's behaviors, 2) Facility-based endline data collection and 3) Community-based endline survey.
The evaluation was originally intended to be a randomized control trial, covering 20 NGO-run urban health facilities under contract with the Urban Primary Health Care Services Delivery Project (UPHCSDP). 10 of the 20 health facilities were randomized to receive the intervention, while the other 10 facilities would serve as the comparison group. Baseline data collection took place in these 20 facilities in October-November 2019. However, the project did not receive approval from UPHCSDP, and interventions were not implemented at the 10 facilities in the treatment group.
Instead, A\&T partnered with 2 other NGOs in Dhaka whose 8 health facilities also provide services in urban areas but are not affiliated with UPHCSDP. These 8 facilities will receive the intervention. Propensity score matching will be used to select 8 of the original 20 facilities under contract with UPHCSDP to serve as the control group.
Baseline data collection in the intervention facilities will take place in February-March 2020. The facility-based end line will take place in May-June 2022, and the community-based endline will take place in June 2022. Data will be collected for the full sample of intervention facilities at baseline (i.e. with the same sample size as at endline), given uncertainty in obtaining government approval to collect endline data from comparison facilities under contract with UPHCSDP. The larger sample from intervention facilities at baseline allows for a shift in evaluation design from quasi-experimental to a pre-post comparison, if the project does not receive government approval.
The study will use mixed data collection methods including: 1) facility assessment; 2) provider survey; 3) case observations (namely ANC visits, child visits \[both sick child and immunization\], and counseling sessions), 4) client interviews and 5) in-depth interview with Program Managers and Field Supervisors.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 4128
- Pregnant women who are visiting the health facilities for ANC visits (at least twice during her pregnancy, around half of clients)
- Mothers with children <12 months of age who are visiting the health facilities for health check-ups or vaccination
- Pregnant women with severe illness or complications
- Mothers with severely ill children
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description MIYCN interventions MIYCN interventions 8 facilities run by 2 NGOs that will receive intensified MIYCN interventions.
- Primary Outcome Measures
Name Time Method Pregnant women's/mother's knowledge of MIYCN topics 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 Total standardized scores of correct answers to questions related to maternal and child nutrition, with higher scores representing higher knowledge.
Facility readiness for nutrition services 15-16 months after baseline in a cross-sectional endline survey scheduled for May-June 2022 Total standardized scores of resources and staffing available to provide nutrition services at the health facility, with higher scores representing higher readiness.
Pregnant women's/mother's utilization of and satisfaction with MIYCN services 15-16 months after baseline in a cross-sectional endline survey scheduled for May-June 2022 Total standardized scores of answers to questions related to utilization of and satisfaction with MIYCN services, with higher scores represent higher utilization and satisfaction.
Quality of nutrition counseling during ANC by health staff 15-16 months after baseline in a cross-sectional endline survey scheduled for May-June 2022 Total standardized scores of correct messages on diet diversity and quantity, IFA and calcium supplementation, weight gain monitoring, early initiation of breastfeeding, and water, sanitation and health by health staff during counseling sessions, with higher scores representing higher quality of counseling.
Service provider knowledge on topics related to maternal and child nutrition 15-16 months after baseline in a cross-sectional endline survey scheduled for May-June 2022 Total standardized scores of correct answers to questions related to maternal and child nutrition, with higher scores represent higher knowledge.
Quality of nutrition counseling during well-child or sick-child visits by health staff 15-16 months after baseline in a cross-sectional endline survey scheduled for May-June 2022 Total standardized scores of correct messages on exclusive and early initiation of breastfeeding, complementary feeding, and water, sanitation and health provided by health staff during counseling sessions, with higher scores representing higher quality of counseling.
- Secondary Outcome Measures
Name Time Method Maternal consumption of calcium tablets 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 The mean number of calcium tablets consumed during pregnancy.
Exclusive breastfeeding among children aged 0-5.9 months 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 The proportion of infants aged less than 6 months who were exclusively breastfed on the day preceding the interview.
Age-appropriate complementary feeding of children aged 6-11.9 months 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 The proportion of children aged 6-11.9 months who received foods from 4 or more food groups and fed the appropriate number of times/meals on the day preceding the interview.
Diet diversity among pregnant women 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 The proportion of pregnant women who consumed foods from 5 or more food groups on the day preceding the interview.
Early initiation of breastfeeding 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 The proportion of women who initiated breastfeeding within one hour of birth.
Maternal consumption of IFA tablets 16 months after baseline in a cross-sectional endline survey scheduled for June 2022 The mean number of IFA tablets consumed during pregnancy.
Trial Locations
- Locations (1)
Data Analysis and Technical Assistance Limited
🇧🇩Dhaka, Bangladesh