The Effects of a Community-driven Nutrition Approach and Block Grants on Child Nutrition in Madagascar

Last registered on November 17, 2025
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Pre-Trial

Trial Information

General Information

Title
The Effects of a Community-driven Nutrition Approach and Block Grants on Child Nutrition in Madagascar
RCT ID
AEARCTR-0009970
Initial registration date
November 13, 2025

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
November 17, 2025, 2:33 PM EST

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

Locations

Country
Madagascar
Region
Southwest

Primary Investigator

Name
Seollee Park
Affiliation
Washington State University
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Other Primary Investigator(s)

PI Name
Christopher Golden
PI Affiliation
Harvard T.H. Chan School of Public Health
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2021-01-17
End date
2023-12-31
Keywords
Behavior, Health
Additional Keywords
Child undernutrition, community-based intervention, social behavior change communication, block grants, maternal and child health, community mobilization
JEL code(s)
I15, I12, O12, C93
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Child undernutrition remains widespread in low-income countries despite decades of individual- and household-focused nutrition programs. This study evaluates a community-driven nutrition approach in rural Madagascar that aims to shift local norms around child feeding and enables communities to invest in nutrition solutions through block grants. One hundred villages are randomly assigned to one of three groups receiving: 1) receiving community-led total nutrition (CLTN), a community-wide nutrition awareness and mobilization approach; 2) receiving CLTN plus small community grants to fund locally chosen nutrition projects; or 3) the control group. We examine effects on nutritional knowledge, child-feeding practices, child nutritional outcomes, child health, maternal well-being and empowerment, and water and sanitation.
External Link(s)

Registration Citation

Citation
Golden, Christopher and Seollee Park. 2025. "The Effects of a Community-driven Nutrition Approach and Block Grants on Child Nutrition in Madagascar." AEA RCT Registry. November 17. https://doi.org/10.1257/rct.9970-1.0
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Experimental Details

Interventions

Intervention(s)
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.

CLTN + Block Grants
In communities assigned to this arm, CLTN is paired with block grants that support locally driven nutrition-related projects. After identifying barriers and priorities during the CLTN launch, community members collectively propose and implement small projects to address local barriers to child nutrition. The minimum grant amount was US$200 and varied in proportion to the number of eligible households in the community.

Intervention (Hidden)
Intervention Start Date
2021-06-14
Intervention End Date
2022-06-30

Primary Outcomes

Primary Outcomes (end points)
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)
Intimate partner violence
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Other IYCF practices (breastfeeding, food consumption by food group, perception of child diet)
Household food consumption and expenditures
Child mortality
Water and sanitation
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study is conducted in the District of Toliara II in southwestern Madagascar. From the 23 communes in the district, nine communes were selected as the study area. Within these communes, 100 fokontany were randomly selected to participate in the evaluation. The study employs a community-based cluster randomized control trial in which each fokontany was randomly assigned to one of three groups: (1) a group receiving the CLTN intervention; (2) a group receiving CLTN combined with community block grants; 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 1,991 households.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Fokontany (fokontany is the smallest administrative unit in Madagascar, consisting of one or more villages)
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
100 fokontany
Sample size: planned number of observations
1991 households (approximately 20 per fokontany)
Sample size (or number of clusters) by treatment arms
CLTN: 25 fokontany
CLTN + block grants: 25 fokontany
Control: 50 fokontany
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Harvard T.H. Chan School of Public Health
IRB Approval Date
2019-10-22
IRB Approval Number
IRB19-1443
IRB Name
Ministry of Public Health, Republic of Madagascar
IRB Approval Date
2020-03-05
IRB Approval Number
N° 040 MSANP/SG/AGMED/CERBM
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials