Impact Evaluation of a Social Franchise Model for Improving Infant and Young Child Feeding and Child Nutrition in Vietnam

Study Overview
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Brief Summary
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Alive & Thrive is an initiative that aims to improve infant and young child feeding practices and reduce childhood stunting. In Vietnam, Alive & Thrive's primary intervention is implemented through a social franchise linked with the government's health system. The impact evaluation is conducted using a cluster-randomized design in which 20 commune health centers (CHC) were assigned to the social franchise model, and 20 CHC were assigned to routine government services. Repeated cross-sectional baseline and endline surveys will be used to assess the public health impact of this intervention. The baseline was in 2010 and an endline survey in the same communities will be conducted in 2014. Mixed methods process evaluation will be conducted in 2011, 2012 and 2013 to study the pathways through which the program impact is achieved.

Detailed Description
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Link provided to journal manuscript describing design of evaluation provides additional detail: http://fnb.sagepub.com/content/34/3_suppl2/S195.full.pdf

Official Title
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Impact Evaluation of a Social Franchise Model Implemented by Alive & Thrive for Improving Infant and Young Child Feeding and Child Nutrition in Rural Vietnam

Conditions
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Child Nutrition, Stunting, Exclusive Breastfeeding, Complementary Feeding

Intervention / Treatment
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* Behavioral: Standard government health services
* Behavioral: Alive & Thrive IYCF franchise services
* Behavioral: Mass media campaign


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children 0-60 months of age Exclusion Criteria: None

Ages Eligible for Study
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Maximum Age: 60 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Comparison area, only standard government services<br>This intervention arm will receive the standard government services offered at CHCs all over Vietnam. In addition, participants in this arm will be exposed to the nationwide mass media campaign. | Behavioral: Standard government health services<br>* This intervention will be basic preventive and curative health services provided by the commune health centers. This includes antenatal care, postnatal care and basic nutrition related counseling.<br>Behavioral: Mass media campaign<br>* Alive & Thrive is implementing a nationwide mass media campaign in 2011, 2012 and 2013, with a focus on improving breastfeeding practices. The mass media intervention includes TV and radio spots as well as an internet site and a telephone hotline.<br>|
| Experimental: A&T Franchise<br>In this arm, the 20 CHCs will offer Alive & Thrive branded franchise services with enhanced quality of IYCF counseling through interpersonal contact between health workers at the commune level and clients who use the commune health services. In addition, the clients could also be exposed to the mass media campaign. | Behavioral: Standard government health services<br>* This intervention will be basic preventive and curative health services provided by the commune health centers. This includes antenatal care, postnatal care and basic nutrition related counseling.<br>Behavioral: Alive & Thrive IYCF franchise services<br>* This intervention includes intensive behavioral counseling to improve infant and young child feeding. A package of 15 counseling contacts that are quality assured and branded will be offered to families of infants and young children. Services might also include user fees.<br>Behavioral: Mass media campaign<br>* Alive & Thrive is implementing a nationwide mass media campaign in 2011, 2012 and 2013, with a focus on improving breastfeeding practices. The mass media intervention includes TV and radio spots as well as an internet site and a telephone hotline.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Exclusive breastfeeding among children 0-6 months of age | Exclusive breastfeeding in children 0-6 months of age is one of the eight WHO-recommended IYCF core indicators will be measured to capture breastfeeding and complementary feeding practices. It is measured using survey based recall by interviewing mothers of children in the age group for the indicator. | 4 years | 
| Child heights and weights (children 24-60 months of age) | Heights and weights of children in the intervention and comparison communes covered by the CHCs in the study will be assessed in 2014. A new sample of children 24-60 months will be measured in the repeated cross-sectional endline survey to measure these outcomes and compute height-for-age, weight-for-age and weight-for-height z-scores based on the WHO growth reference standards. | 4 years | 
| Complementary feeding for children 6-23.9 months of age | Indicators of complementary feeding - diet diversity, minimum acceptable diet, and minimum meal frequency, measured in children 6-23.9 months of age are one of the eight WHO-recommended IYCF core indicators will be measured to capture breastfeeding and complementary feeding practices. These are measured using survey based recall by interviewing mothers of children in the age group for the indicator. | 4 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Early initiation of breastfeeding in children 0-24 months of age | Early initiation of breastfeeding (in the first hour after birth) is measured in children 0-23.9 months of age and it is one of the eight WHO-recommended IYCF core indicators will be measured to capture breastfeeding and complementary feeding practices. These are measured using survey based recall by interviewing mothers of children in the age group for the indicator. Samples for children 0-6 months and 6-23.9 are combined to calculate this indicator | 4 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Child nutrition, Stunting, Exclusive breastfeeding, Complementary feeding, Social franchise, Mass media, Counseling, Facility-based