Community Resilience to Acute Malnutrition

Study Overview
=================
Brief Summary
-----------------
The study evaluates the impact of a multi-sectoral intervention (water, sanitation, and hygiene; training on climate smart activities; care groups for mothers; market gardens) on the prevalence of acute malnutrition as the primary outcome using a randomized intervention trial between 2012-2017 with four points of data collection (2012, 2014, 2015, and 2017).

Detailed Description
-----------------
Concern Worldwide has developed a model of intervention called Community Resilience to Acute Malnutrition (CRAM). This model is based on the need for (a) the introduction of longer-term programming to build community resilience to shocks, while recognising that there may be a need for humanitarian intervention, and (b) a multi-sectoral package of activities given experience in programming from other settings. The goal of the study is to rigorously test the impact of the model and associated activities on community resilience to shocks in the Goz Beida area of Chad. Where community resilience is proxied by the primary outcome variable: acute malnutrition. In order to answer this question, 69 villages had been randomized to either receive the full multi-sectoral program or not. In each village, approximately 20 households were surveyed (randomly selected from a household list from a previous emergency distribution) for a total of 1420 households. Those households were then surveyed in November/December 2012 (prior to the intervention), and again a the same time period in 2014, 2015, and 2017. Data was collected on household demographics, livelihoods, child health, and nutrition, including child (6-59 months) anthropometry.

Official Title
-----------------
Community Resilience to Acute Malnutrition

Conditions
-----------------
Malnutrition, Child

Intervention / Treatment
-----------------
* Behavioral: multisectoral package of activities


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: child is from household with B, C, or D wealth ranking (wealth ranking is from A-D with A being the highest wealth and D being the lowest wealth) child is between the ages of 6-59 months child is present in the selected household at the time of the survey Exclusion Criteria: child has a skin disorder too ill to be measured on height board or weight scale

Ages Eligible for Study
-----------------
Minimum Age: 6 Months
Maximum Age: 59 Months

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Panel cluster randomized intervention trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: multi-sectoral package of activities<br>Villages in the experimental arm received the full multi-sectoral package of village level activities, including having a well dug, a shared latrine installed, training on handwashing and hygiene across the water chain, training on conservation agriculture techniques, care groups for pregnant and breastfeeding mothers, and training on market gardens. | Behavioral: multisectoral package of activities<br>* A multi-sectoral package of village level activities, including having a well dug, a shared latrine installed, training on handwashing and hygiene across the water chain, training on conservation agriculture techniques, care groups for pregnant and breastfeeding mothers, and training on market gardens.<br>|
| No Intervention: Control<br>Villages in the control arm did not receive teh multi-sectoral package of village level activities. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute Malnutrition | prevalence of wasting (weight for age z-score<-2) | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chronic Malnutrition | prevalence of stunting (height for age z-score<-2) | 5 years | 
| height for age | height for age z-score | 5 years | 
| child morbidity | Child ill in the past two weeks | 5 years | 
| weight for height | weight for height z-score | 5 years |