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

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.

2022-03-14

2024-07-31

Height-for-age z-score and stunting status

Stunting status will be defined as height-for-age z-score < -2

Weight-for-age z-score and child development domain scores (cognitive, motor, language, and social)

Child development domain scores will be measured using the Caregiver Reported Early Development Instruments (CREDI)

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

A total of 1,480 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.

Not available

Randomization will be done in an office by a computer

Dusun (sub-village administrative unit in Indonesia)

Yes

284 dusun

1,480 caregiver-child dyads

142 dusun control, 142 dusun treatment

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), and an intra-class correlation coefficient (ICC) of 0.10.