Parental Misperceptions on Child Nutrition in India: Implications for Child Feeding Practices and Growth

NCT06473025 | Active Not Recruiting

• 1 other identifier: APP-24-02211-2
• Study Type: interventional
• Target: 1,542
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this randomized controlled trial is to examine the role of parental misperceptions and information gaps in contributing to poor child dietary practices and high child undernutrition rates in India. The main research questions it seeks to answer are:

1. 1.Do mothers systematically overestimate the nutritional status (height- and weight-for-age percentiles) of their children, relative to global World Health Organization (WHO) standards and other children in their region?,
2. 2.Do mothers underestimate the returns to child nutrition on long-term health, education, and labor market outcomes?,
3. 3.What mechanisms could explain the formation of such misperceptions? Are mothers with higher exposure to undernourished children more likely to overestimate their children's nutritional status?, and
4. 4.Would updating mothers' beliefs about a) their children's true height-for-age and weight-for-age percentiles, and/or b) the returns to child nutrition, improve child feeding practices, utilization of government nutrition services, and child growth outcomes?

Conditions

Child Malnutrition

Keywords

child malnutrition; stunting; india; child feeding; behavioral; misperceptions

Outcome Measures

Primary Outcomes (11)

• Average willingness-to-pay for protein-rich food bundle

  All mothers who participate in the survey will be entered into a lottery to win a bundle of protein-rich food items for their child or, alternatively, a randomly chosen cash prize (amount may range from Rs. 100 to Rs. 2000). 25 lottery "winners" will be chosen randomly at the end of the baseline survey. Mothers will be asked to state their preferences between the food bundle and several potential cash prize amounts, using a multiple-price-list elicitation method. One cash prize amount will be randomly chosen for each mother, and their choice for that amount will be implemented in case they win the lottery. WTP will be measured by the mid-point of the interval of two cash amounts at which a mother switches from preferring to receive cash to preferring to receive food. Possible values range from 0 to 2000. Average willingness-to-pay will be compared between mothers in the treatment groups and the control group.

  Baseline

• Difference between true and perceived height-for-age percentile relative to WHO standards

  The difference between the child's true height-for-age percentile relative to the WHO reference population and the mother's perceived percentile rank. Values may range from 0 to 100.

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Difference between true and perceived weight-for-age percentile relative to WHO standards

  The difference between the child's true weight-for-age percentile relative to the WHO reference population and the mother's perceived percentile rank. Values may range from 0 to 100.

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Knowledge score on returns to child nutrition (Binary)

  Binary variable coded "1" if at least half the prompts (3 out of 6) about the returns to child nutrition are answered correctly, and "0" otherwise. This is a binary indicator constructed based on the knowledge score scale that may range from 0 to 6, with higher scores representing better knowledge.

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Minimum frequency of meals

  Binary variable coded "1" if the child consumed the minimum recommended number of meals in the last 24 hours, based on their age, and "0" otherwise

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Minimum dietary diversity

  Binary variable coded "1" if the child consumed food from at least 5 of the 8 specified food groups in the last 24 hours, and "0" otherwise. This is a binary indicator constructed based on the World Health Organization "Minimum Dietary Diversity - Infant and Young Child Feeding" (MDD-IYCF) scale. Scores may range from 0 to 8, with higher scores representing better outcomes.

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Height-for-age z-score

  Height-for-age z-score at the time of the endline survey

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Weight-for-age z-score

  Weight-for-age z-score at the time of the endline survey

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Weight-for-height z-score

  Weight-for-height z-score at the time of the endline survey

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Consumption of Balamrutham

  Binary variable coded "1" if the child consumed Balamrutham (government-provided therapeutic food) in the last 24 hours, and "0" otherwise

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• CREDI child cognition scale z-score

  The Caregiver-Reported Early Development Instruments (CREDI) Short Form is a validated set of 20 population-level measures of early childhood development (ECD) for children from birth to age three (0-36 months). The responses on this 20-point scale (based on age) will be converted to a norm-referenced standardized Z-score for overall development. The z-scores may range from -6 to +6, with larger scores representing better outcomes.

  During endline survey, an average of 4 months (or 17 weeks) from baseline

Secondary Outcomes (7)

• Change from baseline in height-for-age z-score

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Change from baseline in weight-for-age z-score

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Change from baseline in weight-for-height z-score

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Change from baseline in height

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Change from baseline in weight

  During endline survey, an average of 4 months (or 17 weeks) from baseline

Other Outcomes (3)

• Knowledge score on returns to child nutrition (Continuous)

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Diet adequacy

  During endline survey, an average of 4 months (or 17 weeks) from baseline

• Grams of protein consumed in last 24 hours

  During endline survey, an average of 4 months (or 17 weeks) from baseline

Study Arms (3)

Treatment Arm 1: Relative Nutritional Status

EXPERIMENTAL

Provide information on the true height-for-age and weight-for-age percentiles of the child relative to a reference group of healthy children based on WHO standards

Behavioral: Information on Relative Nutritional Status

Treatment Arm 2: Relative Nutritional Status and Returns

EXPERIMENTAL

Provide information on the true height-for-age and weight-for-age percentiles of the child relative to a reference group of healthy children based on WHO standards AND provide information on the impacts of child undernutrition on health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes, synthesized from existing literature

Behavioral: Information on Relative Nutritional Status; Behavioral: Information on Returns to Child Nutrition

Control Arm

NO INTERVENTION

Status-quo, no intervention

Interventions

Information on Relative Nutritional Status BEHAVIORAL

The intervention involves providing information on the height-for-age and weight-for-age percentiles of children relative to a reference group of healthy children based on WHO standards

Treatment Arm 1: Relative Nutritional Status; Treatment Arm 2: Relative Nutritional Status and Returns

Information on Returns to Child Nutrition BEHAVIORAL

The intervention involves providing information on the effects of child undernutrition on long-term health, education, and labor market outcomes.

Treatment Arm 2: Relative Nutritional Status and Returns

Eligibility Criteria

• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Biological mothers of sampled children aged 7-24 months

You may not qualify if:

• Any medical/health condition that precludes individuals from understanding the study procedures or communicating with study personnel (eg. deafness, inability to speak, mental health conditions)

Sponsors & Collaborators

• University of Southern California: lead
• Center for Effective Global Action (CEGA): collaborator
• Median Insights and Research, India: collaborator

Study Sites (1)

Department of Women Development and Child Welfare

Hyderabad, Telangana, 500038, India

Location

MeSH Terms

Conditions

Child Nutrition Disorders; Growth Disorders; Behavior

Condition Hierarchy (Ancestors)

Nutrition Disorders; Nutritional and Metabolic Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Sneha Nimmagadda, M.Sc.

  University of Southern California

  PRINCIPAL INVESTIGATOR

Study Design

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

Model Details: * Treatment arm 1: Update mothers' beliefs on the height-for-age and weight-for-age percentiles of their child relative to a reference group of healthy children based on WHO standards * Treatment arm 2: Treatment 1 + information on the impacts of child undernutrition on health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes, synthesized from existing literature * Control arm: Status-quo, no intervention

Study Record Dates

• First Submitted: June 13, 2024
• First Posted: June 25, 2024
• Study Start: September 18, 2024
• Primary Completion: May 31, 2025
• Study Completion: May 31, 2025
• Last Updated: October 17, 2024

Record last verified: 2024-10

Data Sharing

• IPD Sharing: Will share
• Time Frame: Within 6 months after publication
• Access Criteria: No access criteria. De-identified data will be made publicly available through an open-access repository (eg. ICPSR).

Locations

IN (1)