An RCT to assess effectiveness of the in-home Growth Monitoring Tool (GroMoTo) in addressing chronic childhood undernutrition in Pakistan
Last registered on January 20, 2020

Pre-Trial

Trial Information
General Information
Title
An RCT to assess effectiveness of the in-home Growth Monitoring Tool (GroMoTo) in addressing chronic childhood undernutrition in Pakistan
RCT ID
AEARCTR-0003248
Initial registration date
December 21, 2018
Last updated
January 20, 2020 1:37 AM EST
Location(s)

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Primary Investigator
Affiliation
Lahore University of Management Sciences
Other Primary Investigator(s)
PI Affiliation
IDinsight
PI Affiliation
Hitotsubashi University
PI Affiliation
Information Technology University
PI Affiliation
Florida International University
Additional Trial Information
Status
In development
Start date
2019-03-01
End date
2020-06-30
Secondary IDs
Abstract
We hypothesize that poor caregivers do not receive frequent and timely feedback on their child’s growth trajectory, which constrains their understanding of the relationship between different childcare inputs and growth. This is especially important for pockets of poverty where the majority of children may be short for their age i.e. the reference child that caregivers have (children from within their community) may also be stunted. Consequently, despite access to resources like information on optimal practices through public health information campaigns and nutrition counseling, caregivers typically do not translate this information into action by adjusting their inputs. Moreover, child development may come into focus only during the regular visits to their local clinic where such feedback can be sought, but these visits can be infrequent and irregular since clinics are often far away and ‘cost’ caregivers in time and money. According to the Multiple Indicator Cluster Survey 2014 in Pakistan, only 4% of HHs in the lowest wealth quintile sought care for their children at a clinic (UNICEF & Sindh Bureau of Statistics, 2014). Another constraint – albeit not necessarily unrelated – could be limited attention to child growth in poor households with taxed attentional capacity (World Bank, 2015). We propose a potential solution - a flexible and low-cost in-home growth monitoring tool called GroMoTo, coupled with counseling and/or (labeled) cash transfer. Fink, et al. (2017) test a passive version of this in Zambia and find positive effects on growth among undernourished children.
External Link(s)
Registration Citation
Citation
Akram, Agha et al. 2020. "An RCT to assess effectiveness of the in-home Growth Monitoring Tool (GroMoTo) in addressing chronic childhood undernutrition in Pakistan." AEA RCT Registry. January 20. https://doi.org/10.1257/rct.3248-3.0.
Former Citation
Akram, Agha et al. 2020. "An RCT to assess effectiveness of the in-home Growth Monitoring Tool (GroMoTo) in addressing chronic childhood undernutrition in Pakistan." AEA RCT Registry. January 20. https://www.socialscienceregistry.org/trials/3248/history/60984.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
The intervention components are:

1. Standard nutrition counseling by community health worker (CHW).

2. Growth Monitoring Tool (GroMoTo): Once every month, the caregiver will be prompted to measure their child’s height (since the sample comprises very young children, the measurement will be a length measure done in supine position) and plot it on the growth chart (this growth-chart will be installed on a wall by the CHW during the first of these visits), with active assistance by the CHW. The CHW will then discuss the results with reference to the healthy norm.

3. Labeled cash transfer: Once every month, the CHW will hand out a fixed amount of cash to the caregiver, with suggestion on using it to buy nutritious food for their child.
Intervention Start Date
2019-04-01
Intervention End Date
2019-12-01
Primary Outcomes
Primary Outcomes (end points)
Height-for-age Z-score; Weight-for-height Z-score
Primary Outcomes (explanation)
Z-scores will be constructed using the WHO child growth standards (WHO 2007).
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
We propose an open-label, 3-arm trial, with randomization at the household level. The three experimental arms are:

1. Standard nutrition counseling by community health worker: CHWs will conduct monthly home visits to provide information to the caregivers on infant and young child feeding (IYCF) practices including consumption of safe drinking water.

2. Counseling + GroMoTo: At each monthly visit, the caregiver will be prompted to measure their child’s height (since the sample comprises very young children, the measurement will be a length measure done in supine position) and plot it on the growth chart (this growth-chart will be installed on a wall by the CHW during the first of these visits), with active assistance by the CHW. The CHW will then discuss the results with reference to the healthy norm, in addition to providing information on IYCF best practices including consumption of safe drinking water.

3. Counseling + GroMoTo + (labeled) Cash transfer: In addition to monitoring and counseling, at each monthly visit, the CHW will hand out a fixed amount of cash to the caregiver, with suggestion on using it to buy nutritious food for their child (hence, labeled cash transfer since suggestion is not enforceable in this context).
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
Household (with at least one child between age 6-24 months)
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
1,350 Households
Sample size: planned number of observations
1,350 Households
Sample size (or number of clusters) by treatment arms
450 Households for each of the three experimental arms
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
1. Height-for-age Z-score (SD; MDE: 0.27) 2. Weight-for-height Z-score (SD; MDE: 0.27)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

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