Optimizing community-health-worker resources to scale promising child nutrition programs in rural Pakistan

Last registered on March 30, 2023
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Pre-Trial

Trial Information

General Information

Title
Optimizing community-health-worker resources to scale promising child nutrition programs in rural Pakistan
RCT ID
AEARCTR-0010313
Initial registration date
March 26, 2023

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
March 30, 2023, 3:34 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Abu Shonchoy
Affiliation
Florida International University
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Other Primary Investigator(s)

PI Name
Agha Akram
PI Affiliation
Mathematica
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PI Name
Uzma Afzal
PI Affiliation
Lahore University of Management Sciences
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PI Name
Akib Khan
PI Affiliation
Uppsala University
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PI Name
Takashi Kurosaki
PI Affiliation
Hitotsubashi University
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Additional Trial Information

Status
In development
Start date
2023-01-01
End date
2025-04-25
Keywords
Health, Welfare
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Evidence from Pakistan (Shonchoy et al., 2020) and Zambia (Fink et al., 2017) suggests that growth posters installed inside the household can be a cost-effective measure to improve nutritional outcomes by increasing salience, changing the parents’ reference for healthy norms and/or helping them better understand the returns to better nutritional inputs. In this proposed policy pilot, we will utilize a cluster-randomized trial design in rural Sindh of Pakistan, which has an under-five stunting rate of over 60%. We plan to test the efficacy of the intervention in a rural setting with intervention variations utilizing light-touch (automated voice-call nudges promoting poster use) against heavy-handed program delivery (community health workers visiting households) to facilitate frequent growth monitoring. We are teaming up with an NGO implementation partner Rural Support Programmes Network (RSPN), which is currently working closely with the Government of Sindh (GoS). Our research findings will help GoS improve the existing program design combating early childhood malnutrition. 
External Link(s)

Registration Citation

Citation
Afzal, Uzma et al. 2023. "Optimizing community-health-worker resources to scale promising child nutrition programs in rural Pakistan." AEA RCT Registry. March 30. https://doi.org/10.1257/rct.10313-1.0
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Experimental Details

Interventions

Intervention(s)
We are conducting a cluster-RCT with households in rural Pakistan, testing two versions of home-based-growth-monitoring (HBGM) vis-à-vis a pure-control group (status-quo).

The two treatments or interventions are as follows:

1. HBGM: An LHW installs the growth-poster inside the home, counsels the caregiver on how to use it, and revisits the household once every two months for one year to support the caregiver in measurement (as well as provide continued counseling on optimal nutritional practices, and record the anthropometric measurement in a booklet as administrative record).

2. HBGM-lite: An LHW installs the growth-poster inside the home, counsels the caregiver on how to use it and on optimal nutritional practices. This one-time visit is then followed by automated voice calls every month to remind the caregiver about using the poster plus encouraging bimonthly visits to the nearby health-facility for height/weight measurement by a healthcare-professional (as well as conveying key messages on best nutritional practices).
Intervention Start Date
2023-04-01
Intervention End Date
2024-03-31

Primary Outcomes

Primary Outcomes (end points)
Stunting, Height-for-age z-score
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Wasting, Weight-for-height z-score.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
We propose a cluster-RCT with households in rural Pakistan testing two versions of home-based-growth-monitoring (HBGM) vis-à-vis a pure-control group (status-quo). The allocation across arms is as follows:

Control: 79 villages (1185 children)
Treatment 1 – HBGM: 60 villages (900 children)
Treatment 2 – HBGM-lite: 60 villages (900 children)
(Note: planned sample size for each cluster/village is 15 children who are 2-18 months old at baseline)
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer, using Stata.
Randomization Unit
Unit of randomization is village, where a village is defined as a cluster of households where the partner NGO, RSPN, has formed a Village Organization (VO).
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
199 Villages
Sample size: planned number of observations
2835 Children
Sample size (or number of clusters) by treatment arms
Control: 79 villages
Treatment 1 – HBGM: 60 villages
Treatment 2 – HBGM-lite: 60 villages
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
For stunting, the aforementioned design yields a minimum detectable effect size of 8.6 percentage points (a 14% decline over a baseline incidence of 62%) when comparing Control and any of the two treatment arms. For comparisons between the two treatment arms, the estimated effect size is 9.2 pp. For height-for-age z-score, the corresponding figures are -0.19 SD and -0.20 SD, respectively. The relevant parameters are fixed as follows: 80% power, 5% significance, and intra-cluster correlations of 0.07 (stunting) and 0.10 (height-for-age z-score) (based on data on rural Sindh from Pakistan DHS 2017-18).
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Research and Development Solutions
IRB Approval Date
2022-09-20
IRB Approval Number
IRB00010843
Analysis Plan