Stunting Prevention Project in Thatta and Sujawal Districts, Sindh Province, Pakistan
Condition: Malnutrition
MeSH terms: Malnutrition; Growth Disorders
Study type: Interventional

Summary: 
      Widespread food insecurity and malnutrition are largely the main impairing factors for human
      capital development in Pakistan. Rates of chronic malnutrition are very high, and acute
      malnutrition is critical: 44% of children under five are stunted and nationwide global acute
      malnutrition (GAM) rates amongst children under five exceed the WHO critical threshold of
      15%. Nutritional status trends also show a deteriorating situation since 1994, when stunting
      rates were at 36%.

      This study evaluates the effectiveness of food based interventions to prevent stunting among
      children under-five years with focus on window of opportunity (1000 days from conception to 2
      years) for addressing stunting. Pregnant women, lactating mothers and children 6-59 months
      will receive supplements on monthly basis in intervention areas, while participants in
      control areas will receive routine public health services available in the study area.
    

Detailed description: 
      Children under two are consuming less than half of their daily energy requirements (560 kcal)
      and lower than recommended levels of micronutrients (one-third of reference nutrient intake
      for Iron and one-half for Zinc). Overall, less than 4% of children were receiving an
      acceptable, diverse diet. Food security and nutrition situation in Sindh province is even
      more dramatic. According to the National Nutrition Survey, 2011, GAM prevalence exceeds 18%
      while anemia levels amongst children under five reached the alarming level of 72.5%. With
      this high level of poverty and food insecurity, a food based approach to prevent stunting,
      together with non- food based approaches is needed.

      Therefore, Division of Women and Child Health, Aga Khan University proposes a research study
      for stronger evidence base on the effectiveness of preventive food/nutrient based
      interventions on reduction of stunting and developing viable programmes on nutrition under
      "real" operational conditions. The effectiveness of the project will be measured in terms of
      the impact of the proposed interventions on the stunting and micronutrient deficiency
      prevalences in the target group (children and mothers). Given the conditions of project
      implementation, a quasi-experimental "double difference" design would be appropriate to
      assess the impact of the intervention. We propose to compare the intervention and
      non-intervention (control) groups before (first difference) and after the intervention
      (second difference). Then, the operational implementation of the research comprises a
      baseline and end line surveys. In addition, a nested cluster randomized controlled trial will
      be implemented to track the evolution of key variables related to the quality of intervention
      delivery and intermediate nutrition outcomes. The control clusters will receive routine
      public and private health services available in the area.

      To achieve its purpose and objectives the project design includes core interventions such as
      complementary feeding using food/nutrient based supplements along with behavior change
      communication, complemented with other non-food interventions. Using a preventative (blanket)
      approach, three types of food/nutrient supplements (Wawamum, MNP & WSB) are considered as
      part of the interventions.
    

Intervention name(s): Wheat Soya Blend (WSB); Wawa Mum; Micronutrient Powders (MNP); Behavior change and preventive health massages
Intervention type(s): Dietary Supplement; Dietary Supplement; Dietary Supplement; Behavioral
Intervention description(s): A monthly ration of 5 Kg of Wheat Soya Blend (WSB) will be given to pregnant women every month during pregnancy and lactating mothers for six months after giving birth; Children 6-23 months of age will receive a daily ration of 50 gram of Wawa Mum during study period; Children 24-59 months of age will receive a sachet of Micronutrient Powders (MNP) in alternate days; Behavior change and preventive health massages will be delivered by lady health workers (LHWs) during monthly visits and in group meetings
Intervention MeSH terms: Micronutrients; Trace Elements
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Stunting; Wasting; Underweight