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Women Supporting Women to Improve Infant and Child Feeding Practices

A

Aga Khan University

Status

Enrolling

Conditions

Child Malnutrition
Health Care Seeking Behavior
Healthy Nutrition
Undernutrition
Health Behavior
Health Knowledge, Attitudes, Practice
Child Rearing

Treatments

Behavioral: Supplemental Print Information
Behavioral: 28-day PD/Hearth Sessions
Behavioral: Community Sensitization

Study type

Interventional

Funder types

Other

Identifiers

NCT05473312
IYCF Study

Details and patient eligibility

About

Undernutrition in the first 2 years of life is the largest preventable cause of death before age 5. Among those who survive, stunting before age two leaves millions with lifelong physical and cognitive deficits, which are difficult to compensate for later in life. Pakistan is home to the second largest number of stunted children in South Asia. The primary goal of this study is to rehabilitate moderately malnourished children aged 7-23 months and enable mothers to sustain this healthy growth at home by changing their infant and young child feeding (IYCF) practices, child care, hygiene and health-seeking behaviours.

Full description

Background and Rationale:

Undernutrition in the first 2 years of life is the largest preventable cause of death before age 5. Among those who survive, stunting before age two leaves millions with lifelong physical and cognitive deficits, which are difficult to compensate for later in life. Pakistan is home to the second largest number of stunted children in South Asia. COVID-19 is projected to increase the prevalence of child malnutrition by almost 14% in the coming year, the majority of which will be in low-middle income countries (LMICs) like Pakistan. In the last two decades, there has been a little reduction in the prevalence of child undernutrition in Pakistan compared to other LMICs. With four in ten children under 5 years of age stunted, one in three underweight, and one in five wasted, Pakistan is a priority country for action to improve infant and young child feeding (IYCF) and caring practices. We will identify uncommon but successful (i.e. Positive Deviant -PD) IYCF behaviours practiced by local mothers of well-nourished children from economically disadvantaged homes, and transfer these practices to mothers with undernourished children who are equally disadvantaged in the wider community.

Goals: To rehabilitate moderately malnourished children aged 7-23 months and enable mothers to sustain this healthy growth at home by changing their IYCF practices, child care, hygiene and health-seeking behaviours.

Hypothesis: A higher proportion of children in the intervention compared to the control group will experience an average weight gain of 400g/month in the first 4 months of the intervention.

Objectives:

  1. Understand local perceptions, experiences, cultural norms around IYCF practices and care,
  2. Discover demonstrably successful IYCF behaviours and strategies using local resources,
  3. Develop and implement a culturally appropriate and context specific intervention, and
  4. Evaluate the intervention.

Approaches: This population health research will take place in two rural communities (tehsils) of Rahim Yar Khan District, Punjab, Pakistan. The tehsils will be randomly selected to either control or intervention. A community-based approach is being used to engage the community in planning, development, implementation and evaluation. Study activities will involve (1) formative research (focus groups and household inquiry/observation) to identify PD IYCF practices, (2) development of a behaviour change intervention informed by the formative research data, (3) delivery of the intervention to mothers and fathers of malnourished children using community sensitization events, print information, and home-like settings for mothers to learn and practice the new behaviours, and (4) a quasi-experimental design using focus groups, household surveys, and children's growth patterns to evaluate the intervention.

Expertise: Our research team includes Canadian and Pakistani experts in community-based research, global health, behaviour change, qualitative and quantitative methods, and child nutrition, with a deep understanding of the community's beliefs concerning health and nutrition.

Expected Outcomes: The project will strategically position our team to guide efforts in Pakistan to improve undernutrition, with the potential to expand this work to other LMICs where our team is affiliated, such as Afghanistan and Uganda. This proposal is aligned with CIHR's mandate to advance global health research that addresses health inequities in LMICs.

Enrollment

350 estimated patients

Sex

All

Ages

7 to 9 months old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Households with a moderately malnourished child (Index child) 7-9 month of age and both parents consenting using thumbprint or written signature (one dyad/household).

Exclusion criteria

  • Any disability that precludes providing informed consent, transient, < 18 yrs (legal consent age).

Trial design

Primary purpose

Prevention

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

350 participants in 2 patient groups

Intervention
Experimental group
Description:
1. Community Sensitization 2. 28-day behaviour practice (Positive Deviance (PD) /Hearth sessions plus home practice) 3. Supplemental Print Information
Treatment:
Behavioral: Supplemental Print Information
Behavioral: 28-day PD/Hearth Sessions
Behavioral: Community Sensitization
Control
No Intervention group
Description:
Control households will continue with usual practices.

Trial contacts and locations

1

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Central trial contact

Sajid Soofi

Data sourced from clinicaltrials.gov

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