Evidence Generation Related to Stunting Prevention in Balochistan
Condition: Stunting; Low Birth Weight; Anemia in Pregnancy
MeSH terms: Birth Weight; Growth Disorders
Study type: Interventional

Summary: 
      The World Food Programme (WFP) has signed MoU with Planning and Development Department of
      Balochistan in collaboration with Nutrition Cell and National Programme for Family Planning
      and Primary Health Care, Balochistan for the prevention of stunting. The project will utilize
      the window of opportunity (1000 days from conception to 2 years) for addressing stunting in
      children under-two years. Therefore project will recruit pregnant women during first
      trimester and newborns who delivered from recruited pregnant women will be followed until the
      age of 2 years. Children 6-12 months of age will be enrolled and followed until the age of
      two years. The interventions included nutritional supplements during pregnancy, lactation and
      for children during 6-24 months of age. The project will be implemented in Lady Health
      Workers (LHWs) covered areas of districts Pishin and Quetta, Balochistan.
    

Detailed description: 
      The World Food Programme (WFP) has signed MoU with Planning and Development Department of
      Balochistan in collaboration with Nutrition Cell and National Programme for Family Planning
      and Primary Health Care, Balochistan for the prevention of stunting. The Stunting Prevention
      interventions will contribute to revert the trends of chronic malnutrition among children
      less than 5 years of age. The intervention is coupled with plans to document the impact
      through credible evidence generation in collaboration with academic institute/s through a
      research based study in Pishin and Quetta Districts.

      Balochistan is the most underdeveloped areas of Pakistan with a very poor health and
      nutrition situation. According to the National Nutrition Survey (NNS) 2011, the prevalence of
      stunting in Balochistan is 52% amongst the highest rates in the country. The prevalence of
      wasting in Balochistan is 16%, indicating a public health emergency. Women and children also
      suffer from some of the world's highest levels of vitamin and mineral deficiencies with
      maternal anaemia at 47% in Balochistan and Vitamin A deficiency in children at 74% in
      Balochistan.

      Although a number of nutrition approaches and actions have been implemented in Pakistan at
      various times, there hasn't been a comprehensive approach to prevent under nutrition in
      general, and stunting specifically. WFP & MOH will be implementing the nutrition
      interventions, and this proposal is widely implemented/evaluated in Pakistan, so the project
      aims to contribute towards to fill the evidence gap for the prevention of stunting through
      multisectoral approaches coupled with appropriate complementary practices in Balochistan. The
      evidence base for undernutrition and stunting prevention globally is actually quite well
      established. There is existent evidence that points to the need to intervene during gestation
      and the first two years of life (1000 days) to prevent child undernutrition and its
      consequences. It suggests that investments in interventions during this window of opportunity
      are likely to have the greatest benefits.

      The effectiveness of the project will be measured in terms of the impact of the proposed
      interventions on the stunting and nutritional outcomes in the target group (children and
      PLW). Given the conditions of project implementation, a mixed-methods study design including
      formative research, cross-sectional baseline & endline surveys, cluster randomized controlled
      trial (RCT) and process evaluation would be appropriate to assess the impact of the
      intervention. The control clusters will receive routine public and private health services
      available in the area. The RCT will utilize the window of opportunity (1000 days from
      conception to 2 years) for addressing stunting in children under-two years. A cohort of
      children between the age of 6-12 month will also be enrolled in the study and will be
      followed up to the age of 24 months.
    

Intervention name(s): Maamta (Nutritious Food Supplement); Wawamum (Lipid-Based Nutrient Supplement)
Intervention type(s): Dietary Supplement; Dietary Supplement
Intervention description(s): Pregnant women will receive 30 sachets of Maamta during pregnancy and first six months of lactation.; Children 6-24 months will receive 30 sachets of Wawamum every month during the study.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention