Community Development and Nutrition Education in Banke District, Nepal: Effect on Child Health and Growth

Study Overview
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Brief Summary
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Heifer Project International is a globally active NGO with more than 400 projects in over 30 countries. The organization uses the introduction of livestock and related training in the development of social capital as tools for poverty alleviation, citizen empowerment, and community development. In a pilot project conducted in 2009-2012, these activities were found to promote some improvement in child health and nutritional status. However, robust enhancement of these important indicators was not observed. Heifer now intends to investigate the efficacy of a nutrition and child health education program in amplifying these effects.

Detailed Description
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Child health and survival remain significant challenges in Nepal. Nepal is ranks 63rd highest in the world for under 5 mortality rate, with 54/1000 children dying before their 5th birthdays and 46/1000 infants dying before their first birthdays. Annually, more than 47,000 children die before reaching age 5 years. At these mortality levels, one in every 22 Nepalese children dies before reaching age 1, and one in every 19 does not survive to his or her fifth birthday. Nutritional status of children is extremely poor, with  29% of children underweight and 41% stunted (respectively, weight and height <-2 SD from median) (UNICEF, 2011) (Ministry of Health and Population et al., 2012). Heifer Project International is a globally active NGO with more than 400 projects in over 30 countries. The organization uses the introduction of livestock and related training in the development of social capital as tools for poverty alleviation, citizen empowerment, and community development. Heifer International recognizes the links between poverty, child malnutrition, and disease. However, improving economic indicators is not always sufficient to improve child outcomes. Thus, the organization now wishes to conduct a systematic assessment to evaluate the effects of introducing a child health and nutrition component into their work, and to clarify the links (if any) between social capital training and child growth and health. In doing so, Heifer International expects to develop a model which could be adapted for use in other regions of the world. The interaction of Heifer community development activities, specific child and family characteristics, and child health and nutritional status will also be explored.

Official Title
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Community Development and Nutrition Education in Banke District, Nepal: Effect on Child Health and Growth

Conditions
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Malnutrition

Intervention / Treatment
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* Behavioral: Training Plus
* Behavioral: Training Only
* Behavioral: No Inputs then Community development and training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: child in household in designated study area of Nepal, age 1 month to 12 years family agrees to enrollment Exclusion Criteria: parent refuse to enroll child

Ages Eligible for Study
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Minimum Age: 1 Month
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Randomized cluster design of households in rural Nepal. Groups will be randomized to receive either: (a) Training Only (livestock management and child nutrition), (b) Training plus enhanced community development activities, or (c) no inputs (Control). After 24 months, groups A and C will receive community development inputs
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Training Plus<br>Intervention: Community Development Training plus enhanced community development activities | Behavioral: Training Plus<br>* Training plus enhanced community development activities<br>|
| Active Comparator: Control<br>No inputs | Behavioral: No Inputs then Community development and training<br>* No inputs for 24 months then add community development and training<br>|
| Experimental: Training Only<br>Intervention: Training Training Only (livestock management and child nutrition) | Behavioral: Training Only<br>* Training Only (livestock management and child nutrition) for 24 months then add community development inputs<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in prevalence of child wasting | measurement of child's weight in kg and height in cm. These measurements will be converted respectively to weight z scores, height z scores and then weight-for-height z scores using World Health Organization standards. The proportion of wasted children (z score <-2) will be determined. | baseline, and then at each study visit (every 6 months over 36 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| child health | Mothers will report the frequency that their child experienced respiratory infection, diarrhea, and/or fever within the 2 weeks prior to the study visit. The presence or absence of each of these symptoms will be scored as either 0 or 1, respectively. These totals will be summed to provide a health score. | at each study visit (every 6 months over 36 months) | 
| household socioeconomic (SES) status | Household possessions will be enumerated (e.g., the presence or absence of such items as refrigerator, telephone, car, computer, radio, television). Using principal components analysis, a household SES score will be calculated. | at each study visit (every 6 months over 36 months) | 
| child developmental status | Developmental status of children 66 months of age will be ascertained using the Ages and Stages Questionnaire (for ages 24-66 months). This test combines observation and parent report. | at one study visit each year, starting 12 months after randomization, then annually | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nepal, child growth, nutrition education, community development