Building Capacity for Sustainable Livelihoods and Health
Condition: Malnutrition; Anemia
MeSH terms: Malnutrition
Study type: Interventional

Summary: 
      Despite recent economic growth in Ghana, the prevalence of childhood malnutrition remains
      high. Wasting prevalence affected 29% among 6- to 8-months-old infants in 2008. Poor
      nutrition contributes to about one-third of child mortality, diminishes cognitive
      development, and is a major determinant of maternal mortality. The specific objectives of the
      5-year project are to: (1) enhance human capacity of government, civil, and private
      institutions through improvement of knowledge and skills of personnel in agriculture,
      nutrition and health, entrepreneurship, and pedagogy; (2) identify information needs of local
      institutions that are not presently met and develop a representative and sustainable
      longitudinal data system to support evidence-based decision-making in programs; (3) increase
      vulnerable households' access to quality services in agriculture/fisheries, nutrition and
      health, and finance; (4) implement integrated intervention activities to improve infant and
      young child and adolescent nutrition outcomes; and (5) examine differential benefits of the
      interventions for diverse vulnerable populations. The project comprises two major activities:
      part I - the creation of a longitudinal data system to support evidence-based decision-making
      in programs, and part II - the implementation of intervention activities to improve nutrition
      outcomes.

      The survey will include demographic, socioeconomic, health, diet, and nutritional status
      information collected annually from a representative same of 1500 households with infants
      (0-12 mo) and 1500 households with adolescents (9-12 y). The data will be analyzed and
      presented rapidly each year to district program and policy leaders to assist them in
      developing their activity plans for the following year.
    

Detailed description: 
      This study will develop a district-level intervention package that builds capacity of local
      institutions to improve economic well-being, food security, health and social and cognitive
      development of populations living in rural Upper Manya Krobo District (UMKD) of Ghana. The
      UMKD Geographic Information Systems Registry estimates a rural population of 74,290 in 190
      communities.

      Selection process:

        1. Of those UMKD communities that are accessible, 136 communities will be randomly
           selected.

        2. All households with infants 0-12 mo of age in a village will be invited to be enrolled.
           We will continue to enroll households until we reach our sample size of 1500 households.
           If necessary, we will expand our number of sampled communities.

        3. All households with adolescents 10-15 y of age in a village, who are not part of the
           infant cohort, will be invited to be enrolled. We will continue to enroll households
           until we reach our sample size of 1500 households.

      Enrollment The survey will be carried out over one day for each community. The field staff
      will briefly explain the purpose and study activity to the caregiver (parent or legal
      guardian who is responsible for the child) of the target child. If the caregiver is
      interested in participating, they will be given the consent form to read, or if illiterate,
      the consent form will be read to them. They will be given time to ask questions and decide if
      they wish to participate. For those who consent, they will sign the consent form or provide
      their finger print as proof of consent. Adolescents will be asked to provide assent. Only
      once consent (and assent for adolescents) is obtained, will the field staff begin the survey.

      Data collection

      The annual survey will consist of questions (drafts are attached) on:

        1. the household demographics, socioeconomic status, agricultural production, government
           services use,

        2. mother's caregiving practices, microcredit use, business activities, physical and mental
           health, anthropometry (weight, height), iron status

        3. infant's diet, anthropometry (weight, height, circumference), iron status

        4. adolescent's diet, anthropometry (weight, height, circumference), iron status,
           educational activities, finance knowledge

      The survey will be administered in the home with the child's caregiver, in a private
      location. THe adolescent will be interviewed privately unless the mother requests to be
      present. It is expected to be about 60-90 minutes in length. All data will be recorded solely
      with the study identification number. The participant's name and home address will be kept
      secure and separately.

      THe interventions will take place with a subgroup of those participating in the annual
      survey. Our two main integrated interventions target critical periods of the life course when
      gender inequalities can have important effects on the short-term and long-term health of both
      men and women. Our first intervention which will begin in January 2014 will offer intensive
      nutrition, health, and agricultural training, along with provision of home gardens and small
      animal husbandry to about 302 of our households with at least one child under the age of 1 y.
      As these will be household-level interventions, both men and women and male and female
      infants (and older siblings) living in these households will benefit from this intervention.
      We will assess the extent to which women retain decision-making authority about the
      allocation of these agricultural resources and whether they benefit their children's health
      and nutrition, using our primary indicators of child diet and nutritional status.

      Our second integrated intervention will focus on reducing anemia among female school-aged
      children. The intervention will start after the baseline with the beginning of the school
      year, September 2014. These interventions will benefit both girls and boys as boys also
      suffer from high rates of anaemia in this district and both sexes continue to have a high
      burden of parasitic infections. In addition, since older girls (starting in primary grade 4)
      are less likely to stay in school and, hence, are disadvantaged with respect to their access
      to these programs, we plan to implement a savings account intervention for girls who
      successfully complete primary grade 5. The amount of the savings account will be relatively
      small (e.g., to cover school uniforms) but along with opening these savings accounts girls
      will gain financial literacy and learn the importance of savings accounts and budgets.
      Increasing girls' education is one of the most effective ways to decrease child mortality.
      According to a recent study, about half of the decline in child mortality in developing
      countries since 1979 can be attributed to women's increased education. Moreover, since our
      integrated intervention will include means to improve iron status of the girls, , we expect
      to significantly lower rates of preconception rates of anaemia among these girls. This
      intervention will help meet one of the key recommendations of The Lancet Maternal and Child
      Nutrition Series, which notes that "A clear need exists to introduce promising evidence-based
      interventions in the preconception period and in adolescents in countries with a high burden
      of undernutrition and young age at first pregnancies" .
    

Intervention name(s): Nutrition and agriculture; Iron-rich food & business literacy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention includes two components: (1) nutrition education on infant and young child nutrition, and (2) agriculture and small animal husbandry intervention to increase women's income and the accessibility of animal source foods for infants and young children.; The intervention includes two components: (1) a behavioural change intervention to improve school meals and increase the available iron in adolescents' diets, (2) savings & business literacy program for young female adolescents to encourage them to stay in school.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Dietary diversity; Infant and young child; Adolescents; Anemia; Rural health