Evaluation of REACTS-IN, an Intervention to Improve Nutrition, Hygiene, and Sexual and Reproductive Health Services

McGill University

Status: Enrolling

Conditions: Gender Equality; Stunting; Diet; Deficiency; Acceptability of Health Care; Empowerment

Treatments: Behavioral: Education intervention on nutrition, gender equity, WASH, sexual and reproductive health rights; Behavioral: Health service training on equitable access to nutrition, health, and sexual and reproductive services; Dietary Supplement: bio-fortified crops; Dietary Supplement: school-based iron-folic acid supplement program

Study type: Interventional

Funder types: Other

Identifiers

NCT06362837

P0117910-001

Details and patient eligibility

About

This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. The evaluation will collect baseline, midline, and end-line data from intervention communities, schools, and health facilities. Only baseline and endline will be collected on the comparison communities. The evaluation objectives are to test if the intervention improved indicators for (i) child anthropometry, (ii) maternal and child dietary practices, (iii) women's empowerment, and (iv) equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators.

Full description

This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention ("Realizing Gender Equality, Attitudinal Change and Transformative Systems in Nutrition", REACTS-IN) to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. REACTS-IN is a multi-sectoral approach, integrating nutrition-related determinants, such as water, sanitation, and hygiene (WASH) interventions and health systems strengthening, to improve access to quality and gender-responsive health systems with increased capacity to prevent and treat malnutrition, especially at the primary health care level. REACTS-IN includes both nutrition-specific (e.g., school-based iron-folic acid supplement program) and nutrition-sensitive (e.g., WASH education) activities delivered through local health systems and/or schools, and communities.

This independent evaluation will include three data collection at baseline, midpoint, and end-line to evaluate the performance indicators for the ultimate and intermediate outcomes. This includes indicators for child anthropometry, maternal and child dietary practices, women's empowerment, and equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators.

The data collection will be carried out with intervention communities as well as with comparison communities. The estimated household sample is 463 households (women, husbands, child)/arm/country per time point, selected through a multi-stage cluster sampling methodology. The household baseline survey with a representative sample of mothers with children (0-5.9 mo; 6-23.9 mo; 24-59.9 mo) will be compared to the values at midpoint (to assess initial impact and the need for program adjustments) and at end-line (to assess the total impact of the project). The surveys will include sociodemographic, economic, and environmental information to assess the indicators for the local context. The evaluation also includes a sample of 500 school-going adolescents (250 boys, 250 girls)/arm/country per time point to assess indicators of knowledge about nutrition, menstrual hygiene management, and sexual and reproductive health. Finally, a sample of approximately 24 health staff and community leaders will provide qualitative data on gender-equitable access to services per arm/country for baseline and end-line.

Although the project also is working in Somalia, this independent evaluation does not include data collection in Somalia.

Enrollment: 13,500 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

(i)Women:

• 15-49 y of age
• biological mother of child in the home who is 0-5.9, 6-23.9, or 24-59.9 months
• has lived in the community for at 12 months

(ii) Husbands/partners:

• no age limit
• lives in the home with index woman
• has lived in community for at least 12 months

(iii) Adolescents:

• 10-19 years
• male or female
• has been in target school for at least 6 months
• lives in the target community

(iv) Children:

• 0-5.9, 6-23.9, or 24-59.9 months

Exclusion criteria

(i) Children:

• no limitation on normal diet or growth (birth defects, illnesses)

Trial design

Primary purpose: Other

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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13,500 participants in 2 patient groups

Intervention

Experimental group

Description:

Includes multiple activities, depending on country, including support of school-based iron-folic acid supplementation program; promotion of bio-fortified crops (sweet potatoes, beans, rice, corn); training on nutrition, water \& sanitation, gender equity for rural communities through community groups and for health facility staff; support to improve gender-sensitive health services for nutrition, sexual and reproductive health,

Treatment:

Dietary Supplement: school-based iron-folic acid supplement program

Dietary Supplement: bio-fortified crops

Behavioral: Health service training on equitable access to nutrition, health, and sexual and reproductive services

Behavioral: Education intervention on nutrition, gender equity, WASH, sexual and reproductive health rights

Comparison

No Intervention group

Description:

No intervention will take place. Standard of care will be available in the health facilities and schools.