Impact of Home-Based Growth Charts on Child Linear Growth in Indonesia

Last registered on February 24, 2022

Pre-Trial

Trial Information

General Information

Title
Impact of Home-Based Growth Charts on Child Linear Growth in Indonesia
RCT ID
AEARCTR-0008952
Initial registration date
February 22, 2022

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
February 24, 2022, 1:54 PM EST

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

Locations

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Primary Investigator

Affiliation
Boston University

Other Primary Investigator(s)

PI Affiliation
Swiss Tropical and Public Health Institute and University of Basel
PI Affiliation
Abdul Latif Jameel Poverty Action Lab
PI Affiliation
Innovations for Poverty Action
PI Affiliation
Gadjah Mada University

Additional Trial Information

Status
In development
Start date
2022-03-14
End date
2023-07-31
Secondary IDs
NCT04222998
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
One-third of children in low- and middle-income countries experience growth faltering. In Indonesia, 37 percent of children under the age of five are stunted (height-for-age z-score1 [HAZ] < -2), with limited progress in recent years. Linear growth deficits are an indicator of undernutrition, caused largely by poor nutritional intake and repeated infections that inhibit micronutrient absorption. These same exposures inhibit child neurodevelopment, contributing to cognitive deficits that often persist well into adulthood.

We developed a home-based growth chart that offers a simple and inexpensive way for caregivers to track their child's growth, along with information and encouragement to improve their child's health and nutrition. Results from a pilot study conducted in rural Zambia suggest that growth charts installed in homes can increase awareness and reduce early-life growth deficits, particularly among children experiencing growth faltering.

The main objective of this study is to assess the impact of growth charts through a cluster-randomized trial in Indonesia.
External Link(s)

Registration Citation

Citation
Fink, Günther et al. 2022. "Impact of Home-Based Growth Charts on Child Linear Growth in Indonesia." AEA RCT Registry. February 24. https://doi.org/10.1257/rct.8952
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
We developed a growth chart prototype during an initial pilot study in Zambia. We adapted and refined the prototype design during additional formative work in Indonesia. After several iterations informed by focus group discussions, key informant interviews, and household piloting, we settled on a version of the growth chart design with five main components:

1. Measurement area -- allows caregivers to track their child's growth according to official World Health Organization (WHO) growth standards presented as a series of colored curves spanning ages 9-36 months of age.

2. Diet information -- provides caregivers with information on good child nutrition presented as locally available ingredients that can be integrated into the standard child diet.

3. Commitment -- at the time of chart installment, the caregiver is asked to make a commitment to providing their child with nutritious foods by placing a sticker with a commitment statement on the chart.

4. Aspiration -- at the time of chart installment, the caregiver is asked to indicate their preferred future career for their child from a set of options (teacher, doctor, police officer, etc.) and place a sticker with a photo of that career on the chart.

5. Child nutrition game -- in the area at the bottom of the chart that is accessible to small children, there is a game that challenges children to find healthy foods hidden within a picture of a local market.
Intervention Start Date
2022-03-14
Intervention End Date
2023-04-30

Primary Outcomes

Primary Outcomes (end points)
Height-for-age z-score and stunting status
Primary Outcomes (explanation)
Stunting status will be defined as height-for-age z-score < -2

Secondary Outcomes

Secondary Outcomes (end points)
Weight-for-age z-score and child development domain scores (cognitive, motor, language, and social)
Secondary Outcomes (explanation)
Child development domain scores will be measured using the Caregiver Reported Early Development Instruments (CREDI)

Experimental Design

Experimental Design
This is a parallel two-arm cluster-randomized controlled trial.

A total of 1,420 caregiver-child dyads will be recruited and enrolled in the study. There are two participant inclusion criteria: 1) the child must be 9-14 months old at enrollment; and 2) the caregiver must be above 18 years old at enrollment. Study dyads will be randomly assigned at the level of dusun (a sub-village administrative unit in Indonesia) to one of two groups: 1) growth charts; and 2) pure control. Data will collected during a baseline survey administered at the time of enrollment and at an endline survey administered at the end of a 12-month intervention period.
Experimental Design Details
Not available
Randomization Method
Randomization will be done in an office by a computer
Randomization Unit
Dusun (sub-village administrative unit in Indonesia)
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
284 dusun
Sample size: planned number of observations
1,420 caregiver-child dyads (5 per dusun)
Sample size (or number of clusters) by treatment arms
142 dusun (710 caregiver-child dyads) control, 142 dusun (710 caregiver-child dyads) treatment
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The study is powered at 80 percent to detect a 0.19 SD improvement in HAZ over the 12-month intervention period, assuming α=0.05, a follow-up rate of 80 percent (attrition of 20 percent, or 1 of 5 enrollees per dusun), and an intra-class correlation coefficient (ICC) of 0.10.
IRB

Institutional Review Boards (IRBs)

IRB Name
Komisi Etik Penelitian Lembaga Penyelidikan Ekonomi Masyarakat Universitas Indonesia (KEP LPEM UI)
IRB Approval Date
2021-11-11
IRB Approval Number
004/UN2.F6.D2.LPM/PPM.KEP/2021
IRB Name
Boston University Institutional Review Board
IRB Approval Date
2020-01-22
IRB Approval Number
H-39613
Analysis Plan

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