Impact Evaluation of the WFP-Implemented Nutrition Program in Malawi

NCT02985359 | Completed

• 1 other identifier: 00005237
• Study Type: observational
• Target: 556
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this evaluation is to assess the impact of a 3.5 year, World Food Program (WFP) supplemental child feeding and nutrition services program in reducing stunting and improving linear growth in children from 6 through 24 months of age in a rural district of Malawi.

Conditions

Undernutrition

Keywords

Program impact evaluation; Malawi; Lipid-based nutrient supplements; Social behavior change communication; Childhood stunting

Outcome Measures

Primary Outcomes (3)

• Change in the prevalence of stunting (%)

  Children will be measured for their length (cm) among children 6 to 23 months of age. The length measures will be used to create indices of length-for-age (LAZ) z-score based on the WHO child growth standards (WHO Multicentre Growth Reference Study Group 2006). The prevalence of stunting (%) is defined as LAZ\<-2. The prevalence of stunting (%) among children 6-23 months of age in the WFP program versus comparison areas at midline (1 year) adjusting for the difference in the prevalence of stunting (%) at baseline between two areas will be a primary outcome at midline (1 year of program implementation). The prevalence of stunting (%) among children 6-23 months of age in the WFP program versus comparison areas at endline (3 years), adjusting for the difference in the prevalence of stunting (%) at baseline between two areas will be a primary outcome at endline (3 years of program implementation).

  Will assess at baseline, midline (1 year), and end line (3 years)

• Change in the prevalence of wasting (%)

  Children will be measured for their length (cm) and weight (kg) among children 6 to 23 months of age. The length and weight measures will be used to create indices of weight-for-length (WLZ) z-score based on the WHO child growth standards (WHO Multicentre Growth Reference Study Group 2006). The prevalence of wasting (%) is defined as WLZ\<-2. The prevalence of wasting (%) among children 6-23 months of age in the WFP program versus comparison areas at midline (1 year) adjusting for the difference in the prevalence of wasting (%) at baseline between two areas will be a primary outcome at midline (1 year of program implementation). The prevalence of wasting (%) among children 6-23 months of age in the WFP program versus comparison areas at endline (3 years), adjusting for the difference in the prevalence of wasting (%) at baseline between two areas will be a primary outcome at endline (3 years of program implementation).

  Will assess at baseline, midline (1 year), and end line (3 years)

• Change in the prevalence of underweight (%)

  Children will be measured for their weight (kg) among children 6 to 23 months of age. The weight measures will be used to create indices of weight-for-age (WAZ) z-score based on the WHO child growth standards (WHO Multicentre Growth Reference Study Group 2006). The prevalence of underweight (%) is defined as WAZ\<-2. The prevalence of underweight (%) among children 6-23 months of age in the WFP program versus comparison areas at midline (1 year) adjusting for the difference in the prevalence of underweight (%) at baseline between two areas will be a primary outcome at midline (1 year of program implementation). The prevalence of underweight (%) among children 6-23 months of age in the WFP program versus comparison areas at endline (3 years), adjusting for the difference in the prevalence of underweight (%) at baseline between two areas will be a primary outcome at endline (3 years of program implementation).

  Will assess at baseline, midline (1 year), and end line (3 years)

Secondary Outcomes (4)

• Change in the prevalence of Iron Deficiency Anemia (IDA) (%)

  Will assess at baseline and end line (3 years) among a subsample

• Change in the proportion of caregiver knowledge and attitude about infant and young child feeding (IYCF) (%)

  Will assess at baseline, midline (1 year), and end line (3 years)

• Change in the proportion of caregiver knowledge, attitude and practice about infant and young child feeding (IYCF) (%)

  Will assess at baseline, midline (1 year), and end line (3 years)

• Change in caregiver practice about handwashing

  Will assess at baseline, midline (1 year), and end line (3 years)

Study Arms (2)

Comparison district

Existing routine community health services by government

Program district

In addition to existing routine community health services by the government, daily 20g Nutributter (Lipid-based Nutrient Supplement, LNS) will be provided to children 6 to 24 month of age and caregivers will participate in Social and Behavior Change Communications (SBCC) activities including the promotion of infant and young child feeding (IYCF) behaviors and water, sanitation and hygiene (WASH) behaviors will be conducted with caregivers.

Dietary Supplement: Nutributter; Behavioral: Social Behavioral Change Communication (SBCC)

Interventions

Nutributter DIETARY_SUPPLEMENT

Daily 20g Nutributter provided to children 6 to 24 month of age

Also known as: Lipid-based nutrient supplement

Program district

Social Behavioral Change Communication (SBCC) BEHAVIORAL

Social Behavioral Change Communication (SBCC) activity focused on improving infant and young child feeding (IYCF) practices and water, sanitation, and hygiene (WASH) behaviors through community groups.

Program district

Eligibility Criteria

• Age: 6 Months+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

In both program and comparison sites the investigators will conduct baseline, midline (1 y), and endline (3 y) panel surveys among children 6-23 months of age and pregnant and lactating women in rural Malawi

You may qualify if:

• Children who live in villages sampled for the cross-sectional survey
• Children between 6.0 and 23.9 months of age
• Pregnant and lactating women who live in villages sampled for the cross-sectional survey
• Pregnant or lactating women with a child between the age of 0 to 5.9 months

You may not qualify if:

• None

Sponsors & Collaborators

• Johns Hopkins Bloomberg School of Public Health: lead
• United Nations World Food Programme (WFP): collaborator
• Kamuzu University of Health Sciences: collaborator
• Children's Investment Fund Foundation: collaborator

Study Sites (1)

Wadonda Consult Ltd

Zomba, Malawi

Location

Related Publications (2)

• Hurley KM, Phuka J, Kang Y, Ruel-Bergeron J, Buckland AJ, Mitra M, Wu L, Klemm RDW, West KP, Christian P. A longitudinal impact evaluation of a comprehensive nutrition program for reducing stunting among children aged 6-23 months in rural Malawi. Am J Clin Nutr. 2021 Jul 1;114(1):248-256. doi: 10.1093/ajcn/nqab010.

  PMID: 33742208 DERIVED

• Kang Y, Hurley KM, Ruel-Bergeron J, Monclus AB, Oemcke R, Wu LSF, Mitra M, Phuka J, Klemm R, West KP Jr, Christian P. Household food insecurity is associated with low dietary diversity among pregnant and lactating women in rural Malawi. Public Health Nutr. 2019 Mar;22(4):697-705. doi: 10.1017/S1368980018002719. Epub 2018 Oct 31.

  PMID: 30378520 DERIVED

Biospecimen

Retention: SAMPLES WITHOUT DNA

Collection of Dried Blood Spots

MeSH Terms

Conditions

Malnutrition

Condition Hierarchy (Ancestors)

Nutrition Disorders; Nutritional and Metabolic Diseases

Study Officials

• Kristen Hurley, PhD

  Johns Hopkins Bloomberg School of Public Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: June 24, 2016
• First Posted: December 7, 2016
• Study Start: January 1, 2014
• Primary Completion: May 1, 2017
• Study Completion: May 1, 2017
• Last Updated: August 18, 2017

Record last verified: 2017-08

Locations

MA (1)