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Improving child development with results of a nimble evaluation: The Mahay Mikolo program in rural Madagascar.
Initial registration date
November 15, 2019
November 20, 2019 3:00 PM EST
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Other Primary Investigator(s)
Catholic University of Madagascar
World Bank Group
University of Nevada - Reno
Additional Trial Information
The goal of this study is to assess the feasibility of implementing a group-based early-child-development curriculum through the existing platform of government-run community-based health and nutrition. This research is a cluster-randomized trial that will assess the effects of integrating ECD activities on community health worker time use and caregiver time use and participation in the program.
The evaluation will compare:
• C: Status quo health and nutrition program
• T: Status quo health and nutrition program + ECD group sessions
• T+: Status quo health and nutrition program + ECD group sessions + enhanced play materials/activities package. This study has four objectives, which will be measured at the community health worker level, and at the caregiver level for caregiver-child dyads (where children are between 6-36 months old at time of intervention launch): 1. Measure how the integration of ECD activities with standard nutrition programming affects the time and task allocation of the community health workers 2. Measure the extent, if any, that the addition of ECD activities crowds out community health worker health/nutrition tasks that are part of the standard community program
3. Measure how the integration of ECD activities affects rates of caregiver participation in nutrition and health activities over time (e.g., during changes in seasonal activities).
4. Measure the impact of enhanced availability and maintenance of age-appropriate play materials/activities on sustained caregiver participation rates in the program.
Fernald, Lia et al. 2019. "Improving child development with results of a nimble evaluation: The Mahay Mikolo program in rural Madagascar.." AEA RCT Registry. November 20.
T: , The intervention arm includes an adaption of the Jamaica Reach Up and Learn home visiting program to a group setting.
The target population are children aged 6-36 months old registered in the community health and nutrition intervention. Children area offered to participate in bimonthly group sessions. Each session will have materials and activities appropriate for children spanning a 6-month range (6-12 m, 12-18 m, 12-24 m, 24-30 m, 30-36 m) and can accommodate a maximum of 10 children per age group. If more households are interested than can be accommodated by the program, interested families will be randomly selected for participation. A total of 50 children per site will be able to participate in the ECD activities at any one time. With bi-monthly meetings, each child will be exposed to 12 sessions for each age group, and is eligible to transition to the next. T+ enhanced play materials/activities package. Caregivers/children participating to the group ECD sessions will be invited to pay within a play space equipped with books, and homemade/purchased age-appropriate toys. The making and maintenance of the toys and materials will be supported by volunteers’ scouts youth groups, who have a capillary presence in the country.
Intervention Start Date
Intervention End Date
Primary Outcomes (end points)
Community health worker time use and workplace productivity.
Caregiver participation rates in group-based health/nutrition activities and early child development programs.
Primary Outcomes (explanation)
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
The nimble evaluation will test the value added and the feasibility of integrating ECD group activities (T) onto a standard of care maternal and child health and nutrition community-based program (C).
There are 75 sites that will comprise the study sample. For the first six months, 50 of the 75 sites will be randomly assigned to the enhanced nutrition program that will include group-based early child stimulation activities (T). For the second six months, the 50 sites in the treatment group (T) will be randomly assigned to either continue with the enhanced group sessions (T), or receive an group sessions and an enhanced play materials/activities package (T+). Monthly administrative data on caregiver participation, and surveys eliciting information on community health worker time use and productivity will be collected throughout the implementation period.
Experimental Design Details
Randomization of sites to treatment arms will be done by research staff remotely using computer software.
Was the treatment clustered?
Sample size: planned number of clusters
75 sites, stratified by region, remoteness, size of the target population and baseline prevalence of underweight/stunting)
Sample size: planned number of observations
150 community health workers (assuming 2 per site)
7500 caregiver/children eligible dyads (assuming an average of 100 children aged 6-36 registered in the administrative data per site).
Sample size (or number of clusters) by treatment arms
C: 25 sites status-quo government health/nutrition program
T: 25 sites health/nutrition program + group ECD sessions ;
T+: 25 sites health/nutrition program + group ECD sessions + enhanced play materials/activities.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
INSTITUTIONAL REVIEW BOARDS (IRBs)