Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Study protocol

Participatory women’s groups and counselling through home visits to improve child growth in rural eastern India: protocol for a cluster randomised controlled trial

Authors: Nirmala Nair, Prasanta Tripathy, Harshpal S Sachdev, Sanghita Bhattacharyya, Rajkumar Gope, Sumitra Gagrai, Shibanand Rath, Suchitra Rath, Rajesh Sinha, Swati Sarbani Roy, Suhas Shewale, Vijay Singh, Aradhana Srivastava, Hemanta Pradhan, Anthony Costello, Andrew Copas, Jolene Skordis-Worrall, Hassan Haghparast-Bidgoli, Naomi Saville, Audrey Prost

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Child stunting (low height-for-age) is a marker of chronic undernutrition and predicts children’s subsequent physical and cognitive development. Around one third of the world’s stunted children live in India. Our study aims to assess the impact, cost-effectiveness, and scalability of a community intervention with a government-proposed community-based worker to improve growth in children under two in rural India.

Methods

The study is a cluster randomised controlled trial in two rural districts of Jharkhand and Odisha (eastern India). The intervention tested involves a community-based worker carrying out two activities: (a) one home visit to all pregnant women in the third trimester, followed by subsequent monthly home visits to all infants aged 0–24 months to support appropriate feeding, infection control, and care-giving; (b) a monthly women’s group meeting using participatory learning and action to catalyse individual and community action for maternal and child health and nutrition. Both intervention and control clusters also receive an intervention to strengthen Village Health Sanitation and Nutrition Committees.
The unit of randomisation is a purposively selected cluster of approximately 1000 population. A total of 120 geographical clusters covering an estimated population of 121,531 were randomised to two trial arms: 60 clusters in the intervention arm receive home visits, group meetings, and support to Village Health Sanitation and Nutrition Committees; 60 clusters in the control arm receive support to Committees only. The study participants are pregnant women identified in the third trimester of pregnancy and their children (n = 2520). Mothers and their children are followed up at seven time points: during pregnancy, within 72 hours of delivery, and at 3, 6, 9, 12 and 18 months after birth. The trial’s primary outcome is children’s mean length-for-age Z scores at 18 months. Secondary outcomes include wasting and underweight at all time points, birth weight, growth velocity, feeding, infection control, and care-giving practices. Additional qualitative and quantitative data are collected for process and economic evaluations.

Discussion

This trial will contribute to evidence on effective strategies to improve children's growth in India.

Trial registration

ISRCTN register 51505201; Clinical Trials Registry of India number 2014/06/004664.
Appendix
Available only for authorised users
Literature
1.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low and middle-income countries. Lancet. 2013;382:427–51.CrossRefPubMed
2.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371:340–57.CrossRefPubMedPubMedCentral
3.
Hertzman C, Wiens M. Child development and long-term outcomes: a population health perspective and summary of successful interventions. Soc Sci Med. 1996;43:1083–95.CrossRefPubMed
4.
De Onis M, Dewey KG, Borghi E, Onyango AW, Blössner M, Daelmans B, et al. The World Health Organisation’s global target for reducing childhood stunting by 2025: rational and proposed action. Matern Child Nutr. 2013;9:6–26.CrossRefPubMed
5.
International Food Policy Research Institute. Global Nutrition Report 2014. Actions and Accountability to Accelerate the World’s Progress on Nutrition. Washington, DC; 2014. http://​www.​ifpri.​org/​sites/​default/​files/​publications/​gnr14.​pdf.​ Accessed 1st April 2015.
6.
Bhutta ZA, Das JK, Rizvi A, Gadey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382:452–77.CrossRefPubMed
7.
8.
Humphrey JH. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet. 2009;374:1032–5.CrossRefPubMed
9.
Spears D, Ghosh A, Cumming O. Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts. PLoS One. 2013;8:e73784. doi:10.1371/journal.pone.0073784.CrossRefPubMedPubMedCentral
10.
Prentice AM, Ward KA, Goldberg GR, Moore SE, Fulford AJ, Prentice A. Critical windows for nutritional interventions against stunting. Am J Clin Nutr. 2013;97:911–8.CrossRefPubMedPubMedCentral
11.
Ruel MT, Alderman H, the Maternal and Child Nutrition Study Group. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382:536–51.CrossRefPubMed
12.
International Institute for Population Sciences (IIPS). Macro International: National Family Health Survey (NFHS 3), 2005–06. India: Volume I. Mumbai: IIPS; 2007.
13.
14.
Mamidi RS, Shidaye P, Radhakrishna KV, Babu JJ, Reddy PS. Pattern of growth faltering and recovery in under-5 children in India using WHO growth standards - a study on First and Third National Family Health Survey. Indian Pediatr. 2011;48:855–60.CrossRefPubMed
15.
Sachdev HS. Overcoming challenges to accelerating linear growth in Indian children. World Bank Brief: India Health Beat; 2011. p. 2.
16.
National Council of Applied Economic Research. Concurrent Evaluation of Integrated Child Development Services. New Delhi: National Council of Applied Economic Research; 2001.
17.
Ruel MT, Menon P, Habicht JP, Loechl C, Bergeron G, Pelto G, et al. Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial. Lancet. 2008;371:417–40.CrossRef
18.
Mazariegos M, Hambidge KM, Westcott JE, Solomons NW, Raboy V, Das A, et al. Neither a zinc supplement nor phytate-reduced maize nor their combination enhance growth of 6- to 12-month-old Guatemalan infants. J Nutr. 2010;140:1041–8.CrossRefPubMedPubMedCentral
19.
Fillol F, Cournil A, Cames C, Sokhna C, Simondon KB. Active malaria morbidity management has limited impact on height status of preschool Senegalese children. J Nutr. 2010;140:625–9.CrossRefPubMed
20.
Chhagan MK, Van den Broeck J, Kany-Kany AL, Mphontshane N, Tomkins A, Bennish ML. Effect on longitudinal growth and anemia of zinc or multiple micronutrients added to vitamin A: a randomized controlled trial in children aged 6–24 months. BMC Public Health. 2010;10:145.CrossRefPubMedPubMedCentral
21.
Vazir S, Engle P, Balakrishna N, Griffiths PL, Johnson SL, Creed-Kanashiro H, et al. Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers. Matern Child Nutr. 2013;9:99–117.CrossRefPubMed
22.
Bhandari N, Mazumder S, Bahl R, Martines J, Black RE, Bhan MK, et al. An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India. J Nutr. 2004;134:2342–8.PubMed
23.
Kinra S, Rameshwar Sarma KV, Ghafoorunissa, Rao Mendu VR, Ravikumar R, Mohan V, et al. Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial. BMJ. 2008;337:1–10.CrossRef
24.
George SM, Latham MC, Frongillo EA, Abel R, Ethirajan N. Evaluation of effectiveness of good growth monitoring in south Indian villages. Lancet. 1993;342:348–52.CrossRefPubMed
25.
26.
27.
Paul VK, Sachdev HS, Malavankar D, Ramachandran P, Sankar MJ, Bhandari N, et al. Reproductive health, and child health and nutrition in India: meeting the challenge. Lancet. 2011;377:332–49.CrossRefPubMedPubMedCentral
28.
29.
30.
31.
Commission P. India Human Development Report 2011: Towards Social Inclusion. New Delhi: Institute of Applied Manpower Research; 2011.
32.
Tripathy P, Nair N, Barnett S, Mahapatra R, Borghi J, Rath S, et al. Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial. Lancet. 2010;375:1182–92.CrossRefPubMed
33.
Kramer MS, Kakuma R. Energy and protein intake in pregnancy. Cochrane Database Syst Rev. 2003;4:CD000032.
34.
Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2006;4, CD004905.
35.
Osrin D, Prost A. Perinatal interventions and survival in resource-poor settings: which work, which don’t, which have the jury out? Arch Dis Child. 2010;95:1039–46.CrossRefPubMedPubMedCentral
36.
Raj A, Saggurti N, Winter M, Labonte A, Decker MR, Balaiah D, et al. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross-sectional study of a nationally representative sample. BMJ. 2010;340:b4258.CrossRefPubMedPubMedCentral
37.
Ramakrishnan U, Nguyen P, Martorell R. Effects of micronutrients on growth of children under 5 y of age: meta-analyses of single and multiple nutrient interventions. Am J Clin Nutr. 2009;89:191–203.CrossRefPubMed
38.
Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr. 2008;4:24–85.CrossRefPubMed
39.
Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, et al. The effect of interventions to improve water quality and supply, provide sanitation and promote handwashing with soap on physical growth in children. Cochrane Syst Rev. 2013;8:CD009382.
40.
Hill Z, Kirkwood B, Edmond K. Family and community practices that promote child survival, growth and development: a review of the evidence. Geneva: WHO; 2004.
41.
Ashworth A, Shrimpton R, Jamil K. Growth monitoring and promotion: review of evidence of impact. Matern Child Nutr. 2008;4:86–117.CrossRefPubMed
42.
Briend A, Maire B, Fontaine O, Garenne M. Mid-upper arm circumference and weight-for-height to identify high-risk malnourished under-five children. Matern Child Nutr. 2012;8:130–3.CrossRefPubMed
43.
Fenn B, Morris SS, Frost C. Do child growth indicators in developing countries cluster? Implications for intervention strategies. Public Health Nutr. 2004;7:829–34.CrossRefPubMed
44.
Hayes R, Moulton L. Cluster Randomised Trials. Chapman & Hall/ CRC: Boca Raton; 2009.CrossRef
45.
DAMOCLES Study Group. A proposed charter for clinical trial data monitoring committees: helping them to do their job well. Lancet. 2005;365:711–22.CrossRef
46.
47.
48.
More SN, Das S, Bapat U, Rajguru M, Alcock G, Joshi W, et al. Community resource centres to improve the health of women and children in Mumbai slums: study protocol for a cluster randomized controlled trial. Trials. 2013;14:132.CrossRef
Metadata
Title
Participatory women’s groups and counselling through home visits to improve child growth in rural eastern India: protocol for a cluster randomised controlled trial
Authors
Nirmala Nair
Prasanta Tripathy
Harshpal S Sachdev
Sanghita Bhattacharyya
Rajkumar Gope
Sumitra Gagrai
Shibanand Rath
Suchitra Rath
Rajesh Sinha
Swati Sarbani Roy
Suhas Shewale
Vijay Singh
Aradhana Srivastava
Hemanta Pradhan
Anthony Costello
Andrew Copas
Jolene Skordis-Worrall
Hassan Haghparast-Bidgoli
Naomi Saville
Audrey Prost
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1655-z

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Associations between parents’ subjective time pressure and mental health problems among children in the Nordic countries: a population based study

Research article

Participation in sport and physical activity: associations with socio-economic status and geographical remoteness

Research article

Does the social context of early alcohol use affect risky drinking in adolescents? Prospective cohort study

Research article

A population-based study on health-related quality of life among urban community residents in Shenyang, Northeast of China

Research article

Prevalence of HIV and syphilis infections among pregnant women attending antenatal clinics in Tanzania, 2011

Research article

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants