Empowering Communities for Maternal and Child Health: A Peer Group Counselling Experiment leveraging SHG Networks

Last registered on March 25, 2024
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Pre-Trial

Trial Information

General Information

Title
Empowering Communities for Maternal and Child Health: A Peer Group Counselling Experiment leveraging SHG Networks
RCT ID
AEARCTR-0013217
Initial registration date
March 20, 2024

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 25, 2024, 11:15 AM EDT

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

Locations

Country
India
Region
Jharkhand

Primary Investigator

Name
Vivek Pandey
Affiliation
Institute of Rural Management Anand
Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status
On going
Start date
2022-05-01
End date
2024-06-30
Keywords
Behavior, Gender, Governance, Health
Additional Keywords
Nutrition, WASH, SHGs, Field Experiment
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
India faces profound challenges in reducing infant and maternal mortality rates and addressing malnutrition, particularly in rural and tribal areas. Despite various governmental initiatives like the National Rural Health Mission (NRHM) and Integrated Child Development Services (ICDS), poor health outcomes persist due to multiple factors including inadequate healthcare access, socio-economic deprivation, and lack of awareness. The study intends to enhance the effectiveness of existing health missions by integrating them with community-driven interventions.

We designed a randomized field experiment that leverages women’s SHG networks to promote adherence to health and nutritional protocols among pregnant and lactating women. By engaging in group-to-peer counselling (facilitated by members of self-help group (SHG)), the expecting and lactating mothers receive crucial information about healthcare services, nutrition, and WASH (Water, Sanitation, and Hygiene). We aim to reduce information asymmetry that are generally linked with: (a) social norms, and (b) lack of awareness. Reduction in information asymmetry among community health workers and women will result in greater healthcare uptake (the demand side) and timely intervention by local health workers (the supply side). As part of the experiment, a cadre of local community agents referred to as “Setu Didi” was recruited and deployed in the treatment areas . They are trained to disseminate health, nutrition, and WASH information among pregnant or lactating women SHG members, or any member in their households. Thus, the Setu Didi acts as communication/coordination channel among the key actors of the intervention: SHG groups, institutional local health workers (ASHA workers and Anganwadi workers), and target women. The intervention integrates the efforts of the National Rural Health Mission (NRHM) and the National Rural Livelihood Mission (NRLM) to combat the dual challenges of healthcare access and nutritional deficiency.
External Link(s)

Registration Citation

Citation
Pandey, Vivek. 2024. "Empowering Communities for Maternal and Child Health: A Peer Group Counselling Experiment leveraging SHG Networks ." AEA RCT Registry. March 25. https://doi.org/10.1257/rct.13217-1.0
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Experimental Details

Interventions

Intervention(s)
Each program village is allocated a community liaison i.e., Setu Didi, who are trained by the Jharkhand State Livelihood Promotion Society (JSLPS) to disseminate health, nutrition, and WASH information. A Setu Didi visits NRLM supported SHGs to conduct training sessions on key health topics such as: (a) the importance and scheduling of antenatal check-ups, (b) awareness of services offered at local healthcare centers (Anganwadi centers), (c) nutritional guidance across various food groups to promote dietary diversity, (d) breastfeeding practices, (e) sanitation and hygiene practices, using pamphlets as visual aids, and (f) setting up kitchen gardens.
The SHGs are mandated to conduct at least one SHG meeting each month at the homes of pregnant or lactating mothers, thereby fostering an environment of peer support and ensuring adherence to health protocols. The husband and in-laws in the target women’s households are also encouraged by the members of the group to participate in these meeting(s).
The target women are informed about regular participation in the Village Health, Sanitation, and Nutrition Day (VHSND) by the ASHA workers, who in turn, is facilitated by the Setu Didi. VHSND plays an important role in enhancing access to and demand for crucial health and nutrition services. It is conducted monthly at Anganwadi Centers and encompasses a comprehensive set of services across four key areas: Health, Nutrition, Sanitation, and Early Childhood Development (ECD). This platform fosters the collaboration of all duty bearers, including VO/SHG members, ASHA worker, Anganwadi Worker (AWW), and Auxiliary Nurse Midwives (ANM). This collaboration aims to increase outreach to the community members.
Intervention Start Date
2022-05-01
Intervention End Date
2024-06-30

Primary Outcomes

Primary Outcomes (end points)
Child level Outcomes: Stunting, Wasting, Underweight, and Birthweight

Women/mother level outcomes:
Number of ante-natal care and post-natal care visits
Whether the child was fed with colostrum
Whether the child had institutional delivery
Number of food groups eaten
Number of iron-folic acid (IFA) tablets consumed

Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Whether the woman was visited by health workers during pregnancy
Whether the woman ever received antenatal check ups
Whether the woman ever received postnatal check ups
Women’s awareness of public health services during antenatal and postnatal periods (Awareness of services provided by ASHA workers, Awareness of services provided by Anganwadi workers, Awareness of services provided by ANM workers)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study employs a two-arm experimental design, utilizing block randomization to allocate the treatment at the village level. A sample of 160 villages were randomly sampled from 8 districts in rural areas of Jharkhand, India. 60 villages were randomly allocated to the treatment group.
In each village, all the pregnant and lactating women are listed and surveyed. All children of the identified women who are under 2 years of age are also identified and surveyed.
Experimental Design Details
Not available
Randomization Method
Using the pre-intervention data, we employed block randomization to randomly allocated villages to either of the experimental arms. For each of 8 districts, these blocks correspond to four quartiles generated from distribution of an index of village level characteristics. The distribution of an indices of village level characteristics is based on the first component of a principal component analysis, that comprises of village population, proportion of households below the poverty line, number of SHGs in the village and health workers per 100 citizens.
Randomization Unit
Village is the randomization unit
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
160 villages
Sample size: planned number of observations
All pregnant and lactating women in a village will be included for the survey. Based on the pre-intervention data, we expect to survey 2400 households, averaging 15 target women per village.
Sample size (or number of clusters) by treatment arms
80 villages in the treatment arm and 80 villages in the control arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
At 80% power, 5% significance level and Intra-cluster correlation calculated from the available baseline data, we find that the minimum detectable effect (at sample ICC) for the woman’s dietary diversity score is 0.29. Given that the mean for this variable is 3.63, this MDE will let us estimate a 7% change in the mean. Our calculations show that the study can observe a detectable change in exclusive breastfeeding rates of 14%, early initiation breastfeeding rates of 14%, and home birth rates of 18%. The MDE for weight-for-age z score is 0.42 σ and 1.6 σ for height-for-age. However, it should be noted that our child anthropometric outcomes were measured at Anganwadi centers by the Anganwadi workers. Given that the scales may not have been calibrated across Anganwadi centers, we found the pre-intervention data on anthropometric measures to be quite noisy. Despite the noise in anthropometric measurements, we can safely assume that the subjects in treatment and control arms are equally distributed in the anthropometric outcomes if their variances are similar. We ran a check for whether the variance of the treatment group matched the variance of the control group in the sample using the Brown and Forsythe's test of variance (Lim & Loh, 1996). The height-for-age z-scores have comparable variances, however, the weight-for-age z scores are significantly different. Therefore, in the post-intervention survey we plan to enhance the accuracy of the anthropometric information by utilizing handheld equipment that is regularly calibrated. Additionally, the anthropometric data shall be self-collected by the study team.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Institute of Rural Management Anand
IRB Approval Date
2023-06-06
IRB Approval Number
IRMA/REC/007-22-06-2023
Analysis Plan