Clinical trial NCT06473025: Parental Misperceptions on Child Nutrition in India: Implications for Child Feeding Practices and Growth
Official title: Parental Misperceptions on Child Nutrition in India: Implications for Child Feeding Practices and Growth
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Child Malnutrition
Keywords: child malnutrition
stunting
india
child feeding
behavioral
misperceptions
Lead sponsor: University of Southern California
Sponsor class: OTHER
Collaborators: name: Center for Effective Global Action (CEGA)
name: Median Insights and Research, India
First posted: 2024-06-25
Enrollment: 1542
Sex: FEMALE
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: * Treatment arm 1: Update mothers' beliefs on the height-for-age and weight-for-age percentiles of their child relative to a reference group of healthy children based on WHO standards
* Treatment arm 2: Treatment 1 + information on the impacts of child undernutrition on health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes, synthesized from existing literature
* Control arm: Status-quo, no intervention
Primary purpose: OTHER

Brief summary: The goal of this randomized controlled trial is to examine the role of parental misperceptions and information gaps in contributing to poor child dietary practices and high child undernutrition rates in India. The main research questions it seeks to answer are:

1. Do mothers systematically overestimate the nutritional status (height- and weight-for-age percentiles) of their children, relative to global World Health Organization (WHO) standards and other children in their region?,
2. Do mothers underestimate the returns to child nutrition on long-term health, education, and labor market outcomes?,
3. What mechanisms could explain the formation of such misperceptions? Are mothers with higher exposure to undernourished children more likely to overestimate their children's nutritional status?, and
4. Would updating mothers' beliefs about a) their children's true height-for-age and weight-for-age percentiles, and/or b) the returns to child nutrition, improve child feeding practices, utilization of government nutrition services, and child growth outcomes?

The study involves an individual-level randomized controlled trial with 1500 mothers of children aged 7-24 months in Telangana, India, with two information treatment arms and one control arm. The first treatment will update mothers' beliefs on the relative height- and weight-for-age percentiles of their children, and the second will provide information on the impacts of child undernutrition on long-term health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes.

The treatment and control groups will be compared to assess if the information treatments improve outcomes related to child feeding practices, consumption of government-supplied therapeutic food, cognition measures, and child growth.

Detailed description: The goal of this randomized controlled trial is to examine the role of parental misperceptions and information gaps in contributing to poor child dietary practices and high rates of child undernutrition in India. This study is guided by two core hypotheses:

1. Parents systematically overestimate the nutritional status of their children: If parents form expectations about how healthy their child is by observing other children around them, then parents in areas with high levels of stunting and wasting may be more likely to believe that their own child is relatively healthy and have a skewed perception of "ideal" height and weight levels.
2. Parents systematically underestimate the returns to child nutrition on long-term health, education, and labor market outcomes: While there is a large literature documenting the effects of child nutrition on the incidence of infectious and chronic diseases, years of education, test scores, and earnings in adulthood, this information is most likely not common knowledge among parents in India, particularly in rural areas.

These misperceptions, if proven true, may create a suboptimal equilibrium for child nutrition outcomes, trapping families in a cycle of inadequate nutrition.

The main research questions are:

1. Do mothers systematically overestimate the nutritional status (height- and weight-for-age percentiles) of their children, relative to global WHO standards and other children in their region?,
2. Do mothers underestimate the returns to child nutrition on long-term health, education, and labor market outcomes?,
3. What mechanisms could explain the formation of such misperceptions? Are mothers with higher exposure to undernourished children more likely to overestimate their children's nutritional status?, and
4. Would updating mothers' beliefs about a) their children's true height-for-age and weight-for-age percentiles, and/or b) the returns to child nutrition, improve child feeding practices, utilization of government nutrition services, and child growth outcomes?

The research design involves an individual-level field experiment with 1500 mothers of children aged 7 to 24 months, with two treatment arms and a control arm:

* Treatment arm 1: Update mothers' beliefs on the height-for-age and weight-for-age percentiles of their child relative to a reference group of healthy children based on WHO standards
* Treatment arm 2: Treatment 1 + information on the impacts of child undernutrition on long-term health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes, synthesized from existing literature
* Control arm: Status-quo, no intervention

The main outcomes of interest are - a) willingness-to-pay (WTP) for a protein supplement/food bundle for the child, measured at the end of the baseline survey, and b) beliefs on child nutrition, c) child feeding practices (frequency of meals, diet diversity, diet adequacy, protein consumption) measured through a 24-hour diet recall module, d) consumption of government-supplied therapeutic food, e) child height, weight, and anthropometric z-scores, f) child health outcomes: episodes of illness, g) household food expenditures, and h) child cognition measures, measured during the endline survey.

Eligibility criteria: Inclusion Criteria:

* Biological mothers of sampled children aged 7-24 months

Exclusion Criteria:

* Any medical/health condition that precludes individuals from understanding the study procedures or communicating with study personnel (eg. deafness, inability to speak, mental health conditions)

Primary outcomes:
measure: Average willingness-to-pay for protein-rich food bundle
timeFrame: Baseline
measure: Difference between true and perceived height-for-age percentile relative to WHO standards
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Difference between true and perceived weight-for-age percentile relative to WHO standards
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Knowledge score on returns to child nutrition (Binary)
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Minimum frequency of meals
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Minimum dietary diversity
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Height-for-age z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Weight-for-age z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Weight-for-height z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Consumption of Balamrutham
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: CREDI child cognition scale z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
Secondary outcomes:
measure: Change from baseline in height-for-age z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Change from baseline in weight-for-age z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Change from baseline in weight-for-height z-score
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Change from baseline in height
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Change from baseline in weight
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Episodes of illness in last 14 days (binary)
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Household food expenditure in last calendar month
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
Other outcomes:
measure: Knowledge score on returns to child nutrition (Continuous)
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Diet adequacy
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
measure: Grams of protein consumed in last 24 hours
timeFrame: During endline survey, an average of 4 months (or 17 weeks) from baseline
Locations:
city: Hyderabad
country: India
facility: Department of Women Development and Child Welfare
state: Telangana
Study officials:
affiliation: University of Southern California
name: Sneha Nimmagadda, M.Sc.
role: PRINCIPAL_INVESTIGATOR
References: