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Protecting Children's Nutritional Gains During a Pandemic: A Study Using Matching Sample Design Under a Randomized Controlled Trial in Urban Pakistan
43 Pages Posted: 19 Apr 2022
More...Abstract
Background: Globally, 24% of children under five are stunted, rising to 38% in Pakistan. Caregivers are crucial to ensure adequate development of children and most community health worker (CHW) programs encourage health-care-facility utilization. The impact of in-home physical growth monitoring and nutrition counseling (IHGMC) is relatively understudied.
Methods: We measured the efficacy of high-frequency IHGMC. Baseline data was collected in July 2019, and the intervention was implemented for six months. An endline survey was administered seven months later (September-October 2020). We randomly allocated 1,188 households with children aged 3-21 months, located in an urban informal settlement in Pakistan, to three intervention groups (1:1:1): monthly IHGMC (T1); T1 coupled with a poster-sized height-for-age Z-score (HAZ) based growth-monitoring chart (T2); T2 complemented with an unconditional monthly cash transfer (T3). CHWs visited homes to record anthropometric measures, and counseled caregivers on age-specific nutrition. Control households (451) that received no input were recruited at end-line. Analysis is based on intention-to-treat estimation using coarsened exact matching method for sample selection – matched on household size, child's age, father's education, mother's education, ethnicity, and neighborhood. The matched sample used for analysis was 1,046 (636 and 410 from treatments and control, respectively). The trial was registered with AER-RCT registry (AEARCTR-0003248).
Findings: Compared to the control group, HAZ in the T1 group increased by 0.58 SD (95% CI 0.33 to 0.83; p=0.0019) and weight-for-age Z-score by 0.43 SD (95% CI 0.20 to 0.67, p<0.01). Treatment-specific component analysis confirmed IHGMC had the largest impact while supplementary components (growth chart and cash transfer) conferred no significant additional benefit on primary outcome measures.
Interpretation: CHWs can substantially improve child anthropometric outcomes in disadvantaged localities through regular IHGMC, and this impact persisted during the pandemic. The use of growth charts and cash transfers did not appear effective in this setting.
Trial Registration: The trial was registered with AER-RCT registry (AEARCTR-0003248).
Funding: World Bank.
Declaration of Interest: We declare no competing interests
Ethical Approval: Ethical approval to conduct this study was obtained from the Institutional
Review Board at Interactive Research and Development (IRD), Karachi. Oral consent
was taken from all caregivers before administering the survey.
Keywords: Home-based Growth Monitoring, Nutritional counseling, Pakistan
Suggested Citation: Suggested Citation