Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 31, 2020
Date Accepted: Aug 4, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of Specialized Nutritious Food Combined with Cash Transfers and/or Behavior Change Communication to Prevent Stunting among Children 6-23 Months in District Rahim Yar Khan, Punjab, Pakistan: Study Protocol
ABSTRACT
Background:
In Pakistan, the prevalence of stunting in children under five years has remained above global critical levels over the two decades, with the current stunting rate being 40.2% in 2018. Children living in rural areas and in the poorest households suffer the most from stunting across the country - 43.2% in rural areas and 51.4% in the lowest wealth quintile. As a continuing public health concern, it is essential that stunting prevention is a national priority in order to ensure human capital development, especially among the poorest households.
Objective:
The primary objective of this study is to determine the effect of specialized nutritious food (SNF), cash transfers (CBTs) and social and behavior change communication (SBCC) on reducing stunting in children 6-23 months.
Methods:
A five-arm cluster randomized controlled trial will be conducted in district Rahim Yar Khan, Punjab, Pakistan. The intervention packages will be: 1) Cash only; 2) Cash with SNF; 3) Cash with SBCC; and 4) Cash with SBCC and SNF. The control arm will receive routine standard-of-care. We will enroll children at 6 months of age and follow on a monthly basis up to 24 months of age. A total of 2000 children, 400 in each arm will be enrolled to detect a 20% reduction in the prevalence of stunting among children at 24 months of age. Length, weight, food intake, compliance to interventions, morbidities and other relevant data will be collected at enrollment and on a monthly basis over the period of 18 months. The process evaluation will assess acceptability of the interventions and potential barriers to implementation through focus group discussions and in-depth interviews with the target population and relevant stakeholders. Furthermore, a cost analysis will be conducted to assess the cost effectiveness of each intervention package.
Results:
All recruitment and follow-up data are complete. Data analyses are yet to be completed. This study will explore the effectiveness of intervention packages comprised of cash transfers from BISP, with or without additional SNF and/or SBCC to prevent childhood stunting.
Conclusions:
The findings of this trial will provide robust evidence as to which intervention package(s) can have significant effect on linear growth of children and to design effective intervention package(s) to prevent stunting in children at 24 months of age. Clinical Trial: ClinicalTrials.gov NCT03299218; https://clinicaltrials.gov/ct2/show/NCT03299218
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