The Effects of Village-level and Household-level Nutrition Programs on Child Nutrition: Evidence from a Field Experiment in Niger

Community-led Total Nutrition (CLTN)
CLTN is a participatory, community-based approach designed to foster collective behavior change and shift local norms related to child nutrition. Modeled after the Community-led Total Sanitation (CLTS) approach, CLTN follows three phases: pre-launch, launch, and monitoring. During the pre-launch phase, communities engage in participatory diagnostics and growth monitoring of children under five to identify key nutrition challenges. In the launch phase, community leaders, volunteers, and CLTN facilitators organize a one-day public event, including skits, puppet shows, and community discussions, to raise awareness and mobilize collective commitments toward improving child nutrition. The monitoring phase involves regular community meetings to review progress and reinforce commitments. The total length of the CLTN intervention is approximately one year, and all members of the community are invited to participate.

Care Groups
Care Groups are a community-based behavior change model in which volunteer “Lead Mothers” receive regular training from a Promoter and then share these lessons with 10–15 neighboring pregnant and lactating women through household visits and small-group meetings. This cascading structure provides extended coverage of beneficiary households and promotes adoption of key maternal and child nutrition, hygiene, and health behaviors during the first 1,000 days.

2021-08-30

2022-08-08

Participation in CLTN
Infant and young child feeding (IYCF) knowledge
IYCF practices (child diet diversity, feeding frequency, minimum acceptable diet)
Child physical growth (height-for-age Z scores, weight-for-age Z scores)
Child morbidity
Women empowerment (subjective well-being, autonomy, decision-making)
Water and sanitation

Other IYCF practices (breastfeeding, food consumption by food group, perception of child diet)
Household food consumption and expenditures
Child mortality
Intimate partner violence

The study is conducted in the Magaria district of the Zinder region in the southeast of Niger. We randomly selected two communes, Sassoumbroum and Dungass, from this district. Within these communes, 105 villages were randomly selected to participate in the evaluation. The study employs a community-based cluster randomized control trial in which each village was randomly assigned to one of three groups: (1) a group receiving the Care Group approach; (2) a group receiving Care Groups with Community-led Total Nutrition (CLTN); and (3) a control group that did not receive either intervention during the study period.

Eligible study participants were households with pregnant women or mothers/caregivers (aged 18-49) of children under the age of two at baseline. In each village, approximately 20 eligible households were randomly selected to be enrolled in the baseline and follow-up surveys, resulting in a total sample size of 2,084 households.

Not available

Randomization done in office by a computer

Village

Yes

105 villages

2084 households (approximately 20 per village)

Care group only: 35 villages
Care group and CLTN: 35 villages
Control: 35 villages