Effectiveness of SNF, Cash and BCC to Prevent Stunting Among Children 6-24 Months in Rahim Yar Khan, Pakistan

NCT03299218 | Completed

• 1 other identifier: CBT Study Rahim Yar Khan
• Study Type: interventional
• Target: 2,179
• Locations: 1 country
• Sites: 1

Brief Summary

Malnutrition is a public health problem, with long-lasting physiological consequences and increased risk of morbidity and mortality. It can be recognized as one of the key obstacles in national development, due to its influence on individual productivity, school performance and physical work capacity. Malnutrition is a hidden crisis in Pakistan, with rates increasing during the last decade. High prevalence of food insecurity, illiteracy, lack of nutritional knowledge, poor hygiene status, and under recognized role of nutrition are some of the possible causes. The situation of malnutrition in Pakistan necessitates an urgent need for addressing its causes through various nutrition interventions, in order to ensure a bright future for the coming generations. Although, malnutrition is a major problem across Pakistan, its burden and implications in the remote districts of Punjab are quite evident. The levels of undernutrition in district Rahim Yar Khan are high, with 47% of children being underweight. These numbers also highlight the presence of long-term undernutrition in the district, as evidenced by 45% of the children being stunted in 2014. Given the alarming situation of child malnutrition in district Rahim Yar Khan, the World Food Program (WFP) Pakistan is proposing an intervention program comprised of cash-based transfers, specialized nutritious foods and behaviours change communication to prevent stunting in district Rahim Yar Khan, province Punjab. The interventions will be delivered through the existing health system and Benazir Income Support Programme (BISP). It is anticipated that the intervention will reduce the widespread macro and micro nutrient malnutrition and food insecurity in the targeted areas. Furthermore, to ensure the presence of adequate evidence to persuade policymakers for further scaling up, it is essential that an impact evaluation be conducted. Therefore, the Department of Paediatrics and Child Health, Aga Khan University (AKU) using robust methodologies on a representative sample size in the district of Rahim Yar Khan to assess the effectiveness of the WFP interventions on process and outcome indicators.

Conditions

Stunting

Keywords

Specialized Nutritious Food (SNF); Social and Behaviour change communication (SBCC); Cash-based transfers

Outcome Measures

Primary Outcomes (3)

• Reduction in stunting

  10% reduction in stunting in children

  18 months

• SBCC package on the basis of formative research

  SBCC package will be developed on the basis of formative research

  3 months

• Cost-effectiveness of intervention packages for prevention of stunting in children

  Cost effectiveness analysis will run through the full three years of the program cost

  18 months

Secondary Outcomes (7)

• Weight gain in kilograms

  18 months

• Length gain in centimeters

  18 months

• Impact of the intervention on micronutrient deficiencies

  At 24 months of age

• Improvement in IYCF practices

  18 months

• Improved nutrition, hygiene and health related knowledge and practices

  18 months

Study Arms (5)

Control

NO INTERVENTION

Receiving current Government of Punjab health services

Cash-based transfers

EXPERIMENTAL

Cash-based transfers only by BISP

Other: Cash

Cash with SBCC

EXPERIMENTAL

Cash-based transfers and Social \& behaviour change communication (SBCC)

Behavioral: Social and behaviour change communication (SBCC); Other: Cash

Cash with SNF (Wawamum)

EXPERIMENTAL

Cash-based transfers and SNF (Wawamum)

Dietary Supplement: SNF (Wawamum); Other: Cash

Cash,SNF (Wawamum) & SBCC

EXPERIMENTAL

Cash-based transfers, SNF (Wawamum) and SBCC

Dietary Supplement: SNF (Wawamum); Behavioral: Social and behaviour change communication (SBCC); Other: Cash

Interventions

SNF (Wawamum) DIETARY_SUPPLEMENT

A monthly ration of 30 sachets of SNF (one 50 gram sachet of Wawamum per child per day) will be provided by LHWs. Each recruited child will receive SNF on a monthly basis for the duration of 18 months during his/her age of 6-24 months.

Cash with SNF (Wawamum); Cash,SNF (Wawamum) & SBCC

Social and behaviour change communication (SBCC) BEHAVIORAL

SBCC messages will be delivered by LHWs in their monthly routine household visits. Male and female group sessions will be arranged on quarterly basis with the help of health committees.

Cash with SBCC; Cash,SNF (Wawamum) & SBCC

Cash OTHER

Cash totaling 1600 rupees per month will be transferred by BISP throughout the study period.

Cash with SBCC; Cash with SNF (Wawamum); Cash,SNF (Wawamum) & SBCC; Cash-based transfers

Eligibility Criteria

• Age: 6 Months - 7 Months
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• BISP beneficiary for intervention arms and poverty score between 16.18 - 20.00 according to the BISP approach for control group;
• Living in the catchment area of LHW;
• Willing and able to provide written informed consent for the study.

You may not qualify if:

• Non BISP households
• Planning to migrate form the study area in next 18 months
• Unable to provide written informed consent
• Children with severe malnutrition and/or chronic illness

Sponsors & Collaborators

• Aga Khan University: lead
• Benazir Income Support Programme (BISP): collaborator
• Punjab Health Care Commission: collaborator
• World Food Programme (WFP): collaborator

Study Sites (1)

Tehsil Rahim Yar Khan

Rahim Yar Khan, Punjab Province, 64200, Pakistan

Location

Related Publications (3)

• Onah MN, Khan GN, Kureishy S, Bourdaire J, de Pee S, Garzon C, Ihtesham Y, Akbar N, Soofi SB. The cost-effectiveness of a cash-based transfer, specialised nutritious food, and social and behaviour change communication intervention package to prevent undernutrition among children 6-23 months in Pakistan: A cluster randomised controlled trial. J Glob Health. 2024 Nov 22;14:04186. doi: 10.7189/jogh.14.04186.

  PMID: 39575728 DERIVED

• Soofi SB, Ariff S, Khan GN, Habib A, Kureishy S, Ihtesham Y, Hussain M, Rizvi A, Sajid M, Akbar N, Garzon C, de Pee S, Bhutta ZA. Effectiveness of unconditional cash transfers combined with lipid-based nutrient supplement and/or behavior change communication to prevent stunting among children in Pakistan: a cluster randomized controlled trial. Am J Clin Nutr. 2022 Feb 9;115(2):492-502. doi: 10.1093/ajcn/nqab341.

  PMID: 34612491 DERIVED

• Khan GN, Kureishy S, Ariff S, Habib MA, Usmani AA, Mubarik A, Hussain M, Akbar N, Rodriguez de Castro P, Garzon AC, de Pee S, Soofi SB. Specialized Nutritious Food Combined With Cash Transfers and Social and Behavior Change Communication to Prevent Stunting Among Children Aged 6 to 23 Months in Pakistan: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc. 2020 Aug 24;9(8):e19001. doi: 10.2196/19001.

  PMID: 32831183 DERIVED

MeSH Terms

Conditions

Growth Disorders

Interventions

CASP8 and FADD-Like Apoptosis Regulating Protein

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Death Domain Receptor Signaling Adaptor Proteins; Adaptor Proteins, Signal Transducing; Intracellular Signaling Peptides and Proteins; Peptides; Amino Acids, Peptides, and Proteins; Tumor Necrosis Factor Receptor-Associated Peptides and Proteins; Apoptosis Regulatory Proteins; Carrier Proteins; Proteins

Study Officials

• Sajid B Soofi, FCPS, MBBS

  Aga Khan University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: 1. Control Group 2. Cash-based transfers only by BISP 3. Cash-based transfers and Social \& behaviour change communication (SBCC) 4. Cash-based transfer and SNF 5. Cash-based transfers, SNF and SBCC

Study Record Dates

• First Submitted: August 12, 2017
• First Posted: October 3, 2017
• Study Start: May 26, 2017
• Primary Completion: July 31, 2019
• Study Completion: July 31, 2019
• Last Updated: March 19, 2020

Record last verified: 2020-03

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)