Improving Nutrition, Health and Livelihoods Through Enhanced Homestead Food Production: A Strategy to Reduce Child Marriage in Bangladesh
试验速览
- 阶段
- 不适用
- 入组人数
- 1,200
- 试验地点
- 2
- 主要终点
- Household income
研究概览
简要总结
Child marriage leads to pregnancy in adolescence, a root cause of both malnutrition and the intergenerational cycle of malnutrition. Two-thirds of Bangladeshi girls are married before 18 years, nearly half become pregnant before 19, and the rates of stunting and underweight are 26% and 36%, respectively. There are well-established risks of adolescent pregnancy for both mother (impaired growth and development due to nutrient reallocation for pregnancy and lactation), and infants (increased risk of low birth weight and small-for-gestational-age). Poor sexual and reproductive health (SRH), infant and young child feeding (IYCF), and water, sanitation, and hygiene (WASH) knowledge could impair the nutritional and health status of the whole family, sparking intergenerational issues.
The investigators propose to investigate the efficacy of a gender-transformative enhanced homestead food production (EHFP) program to prevent child marriage, and in turn, adolescent pregnancy-induced malnutrition among girls aged 13-15 years in a high-risk area for child marriage, Khulna Division, southern Bangladesh. The investigators will conduct a cluster-randomized controlled trial in which n=1200 girls in after-school Adolescent Clubs will participate in a 24-month program teaching women's empowerment through hands-on workshops. All participants (control and EHFP groups) will be exposed to SRH, WASH, and IYCF, while those in the EHFP group will also receive EFHP training and inputs intended to improve nutrient intake and provide an income source for the adolescent girls' family.
Investigators hypothesize that girls in the EHFP group will have lower rates of marriage and pregnancy, and improved food security, dietary diversity, nutritional status, IYCF, WASH, and SRH knowledge/practices.
详细描述
Introduction: Over the past 20 years, Bangladesh has heavily invested in improving the health and nutrition status of its adolescent population, however despite this investment, adolescents remain a vulnerable group. A recent large scale survey found that 26% of adolescents were stunted and 36% had low BMI(1). Nationally, 31% of married adolescent girls between the ages of 15 to 19 years were found to be underweight and another 13 percent were stunted (2). Adolescent women's sexual and reproductive health (SRH) knowledge is also a concern in Bangladesh, as unmarried adolescents have little access to SRH services (3). Adolescent health status is further exacerbated by high fertility rates with two-thirds of Bangladeshi women married before their eighteenth birthday while almost half of women are under 19 years at the time of their first pregnancy (4). Furthermore, data from the Bangladesh Integrated Households Survey 2017 reports that more than half of the children born to women under 15 were stunted while only 51% of married adolescents were using modern contraceptives (5). Statistics are worse in southern Bangladesh, particularly in Khulna Division, where the average age at first marriage is 15.5 years, with more than 8% experiencing birth intervals of less than 24 months and 32% of married adolescents age 15-19 years not using any form of contraceptive (5).
Adolescents are an important target group as they have the potential to contribute to society and earn income for their full adult life in addition to the intergenerational impact of undernourished teens having undernourished children, adversely impacting the health of future generations as well as long term human capital (6). Adolescents face risks as they move from adolescence to adulthood including poor nutritional status, inadequate (SRH) knowledge, insufficient education, early marriage, early pregnancy and social stigma (1,7). Lack of SRH has a direct impact on health and nutrition. For the past several decades, various organizations including the National Nutrition Services (NNS) in the Directorate General of Health Services (DGHS) under the Ministry of Health, Ministry of Women and Child Affairs (MoWCA); Non-Governmental Organizations; and Civil Society Organizations have undertaken initiatives to address issues related to ensuring the overall wellbeing of the adolescents. Such interventions have often been fragmented with limited scalability, sustainability and replicability. Since the improvement of adolescent nutrition in multifaceted, these efforts lacked a full-service delivery approach that would enable a comprehensive and systematic multisectoral engagement. Moreover, detailed evidence regarding the long-term effectiveness of such efforts in reaching their overarching goals is limited. The Ministry of Women and Children Affairs (MOWCA) has initiated the Adolescent Club Program of Bangladesh to mainstream SRH education through a club-based intervention to empower adolescents but which is limited to improving SRH knowledge(8).
In 2019, Helen Keller International in collaboration with the Mount Saint Vincent University, Canada (MSVU) initiated a three year research project in Debhata Sub-District of the Satkhira District in Khulna Division, funded by the International Research and Development Center (IDRC) Canada to increase production of diversified and nutrient-rich food, increase income generation from transferred assets, access to income, and access to improved knowledge and awareness on nutrition and adolescents along with essential nutrition actions and essential hygiene actions. SRH information is also included to improve outcomes including self-efficacy and agency to delay child marriage. These activities are underscored by a transformative approach to gender equality at the household and community level to improve intra-household communication and respect and intra-community equality and inclusion.
Objectives: To establish whether a gender transformative enhanced homestead food production (EHFP) model can improve household food security, diet, nutrition, income, and sexual and reproductive health outcomes to delay child marriage among Bangladeshi girls.
Specific objectives:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 13 Years 至 15 Years（Child）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •Not be married,
- •Are not sick
- •Have never been pregnant,
- •Be aged 13-15 years,
- •Be willing to attend monthly workshops at their local Adolescent Club,
- •Provide written assent to participate from adolescent, and have their primary caregiver (e.g. father/mother) provide written consent for participation,
- •Have access to a minimum of about 60 sq.m (1.5 decimal) of homestead land available for EHFP activities at their home.
排除标准
- •Not ill or in unhealthy condition
结局指标
主要结局
Household income
时间窗: Baseline to twenty four months of the intervention
Monthly household income will be measured in US$ by observing changes from baseline to endline
Prevalence of child marriage
时间窗: Baseline to twenty four months of the intervention
This is a continuous variable and the goal is to delay the marriage of the adolescent girl until after 16th birthday.
Adolescent nutrition status-Anemia
时间窗: Baseline to twenty four months of the intervention
Anemia will be measured by hemoglobin concentration in the blood and, for this particular indicator, will be collected among adolescent girls (13-15 years). Non-pregnant adolescent girls with a hemoglobin concentration less than 12g/dl will be classified as anemic. The numerator for this indicator is the sample-weighted number of anemic adolescent girls 13-15 years in the sample. The denominator is the sample-weighted number of adolescent girls 13-15 years in the sample with hemoglobin data.
Adolescent nutrition status-Underweight
时间窗: Baseline to twenty four months of the intervention
BMI is an anthropometric index of weight and height that is defined as body weight in kilograms divided by height in meters squared. BMI is used to assess underweight status of adult and adolescents.
次要结局
- Food security status of the household(Through study completion, an average of 4 months)
- Adolescent empowerment and participation in household decision-making(Through study completion, an average of 4 months)
- Adolescent nutrition status-Dietary diversity(Through study completion, an average of 4 months)
研究者
Asif Chowdhury
Head of Monitoring, Evaluation and Research
Helen Keller International