To What Extent do Systems Strengthening Interventions and Engagement With Local Governance Improve the Quality and Co-coverage of Nutrition Services in Gujarat, India? A Cluster-randomized Evaluation
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 2,500
- 试验地点
- 2
- 主要终点
- Quality of delivery of health and nutrition interventions
研究概览
简要总结
Progress on child growth outcomes such as stunting requires both direct and indirect actions across multiple sectors. Recognizing the importance of multisector approaches in reducing child undernutrition, Alive & Thrive (A&T) India aims to improve the quality of health and nutrition services, as well as their convergence at the household level with other available nutrition-sensitive services, in order to improve MIYCN behaviors, and ultimately decrease malnutrition in Gujarat. In line with government priorities, A&T designed a suite of system strengthening interventions including capacity building, supportive supervision, strategic use of data, improved food supplementation and engagement with local governance to improve the quality and co-coverage of nutrition-relevant services in three districts in Gujarat. This proposed evaluation aims to assess the feasibility of integrating multi-sectoral interventions using a cluster-randomized design with cross-sectional baseline and endline surveys.
详细描述
This study uses a cluster-randomized design with cross-sectional baseline and endline surveys to generate a proof-of-concept around an implementation model that aims to strengthen systems for delivery of individual interventions and to strengthen convergence of multiple interventions on the same households/families. The primary objectives of the study are to answer the following questions:
- To what extent and through which pathways can overall system strengthening approaches improve quality of delivery of health and ICDS services?
- To what extent and through which pathways do system strengthening approaches and focused local efforts to engage multiple sectors improve coverage of individual interventions and co-coverage of multiple interventions in the first 1,000-days?
- Can efforts to improve the nutritional value and palatability of take-home rations within the ICDS increase acceptability and use?
This study will also measure a range of secondary outcomes, for each research question as well as outcomes that pertain to the pathways of impact of the five intervention components. These include
- MIYCN capacity building
- Strengthening Supportive Supervision (SS) of the ICDS & Health Supervisory Cadre
- Strategic Use of Data (SUD) & Convergent Action Plan
- Involving Panchayati Raj Members (PRIs) for improved Co-Coverage of nutrition services
- THR offering refinement
Prior to the baseline survey, 13 out of 26 blocks from three districts randomly allocated to receive interventions. Another 13 blocks from the same three districts were randomly allocated to the comparison groups which received standard government services. The selection of three districts was based on the discussion between A&T team and the Government of Gujarat. A team comprising of representatives from A&T, IFPRI and local government worked closely to ensure matching and comparability between the intervention and comparison blocks using a propensity score matching method prior to randomization to intervention or comparison groups.
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
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Mothers with children <2 years of age who are registered with the Anganwadi Center to receive services under the ICDS
- •Pregnant women in first, second and third trimester who are registered with the Anganwadi Center to receive services under the ICDS
- •Frontline health workers in the areas
- •Supervisors/managers in the areas
- •Key informants from the Panchayati Raj Institutions (PRI)
排除标准
- •Women who are not currently registered with the local Anganwadi center to receive ICDS services
- •Pregnant women with severe illness or complications
- •Mothers with severely ill children
- •Mental health problems that make it difficult for the respondent to answer the questions
结局指标
主要结局
Quality of delivery of health and nutrition interventions
时间窗: During pregnancy (about 9 months)
Proportion of beneficiaries receiving all ANC care items (weigh, blood sample taken, blood pressure measured, urine sample taken, abdomen checked),THR supplements and counseling.
Co-coverage of multiple interventions from across sectors
时间窗: During pregnancy (about 9 months) and up to 24 months postpartum
* For pregnant women: Proportion of pregnant women receiving at least 7 out of 14 interventions (\>=4 ANC, received IFA, tetanus, weighed during ANC, breast feeding and cord counselling, received THR, health \& nutrition education, mosquito net, improved sanitation, clean cooking fuel, met ASHA worker at home, met AWW at home) * For mothers with children \<2y: Proportion of mother-child pairs receiving at least 12 out of 24 interventions (≥ 4 ANC visits, received IFA, tetanus, deworming, weighed during ANC, breastfeeding and cord-care counselling, food supplementation, health and nutrition education, mosquito net, institutional birth, postnatal care for mothers and babies, postnatal food supplementation, postnatal health and nutrition education, counselling on child growth, deworming, pediatric IFA, Vitamin A supplementation, child weighing, home visits by AWW or ASHW, HHs with improved sanitation facility and cooking fuel)
Acceptability of reformulated take home ration by pregnant, lactating women and children
时间窗: During pregnancy (about 9 months) and up to 24 months postpartum
Total standardized scores of acceptability to five THR organoleptic properties (taste, smell, texture, color, difficulty of eating), with higher scores representing higher acceptability.
Use of reformulated take home ration by pregnant, lactating women and children
时间窗: During pregnancy (about 9 months) and up to 24 months postpartum
Proportion of beneficiaries who consumed THR during pregnancy, lactation or early childhood
次要结局
- MIYCN knowledge of FLWs(In the 6 months prior to interview date)
- Panchayati Raj Members (PRI) member involvement(In the 6 months prior to interview date)
- Decentralized programmatic decision-making using data(In the 6 months prior to interview date)
- Mother IYCF knowledge and practices(During pregnancy (about 9 months) and up to 24 months postpartum)
- Supportive supervision(In the 6 months prior to interview date)