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General

Study Overview

Title:

Evaluation of the impact of Suchana on preventing chronic malnutrition: a cluster randomized trial

Study is 3ie funded:

No

Change History for Study is 3ie funded

Changed On	Previous Value
08/16/2019	Yes

Study ID:

RIDIE-STUDY-ID-5d5678361809b

Initial Registration Date:

08/16/2019

Last Update Date:

08/16/2019

Study Status:

Ongoing

Location(s):

Bangladesh

Abstract:

In Bangladesh, the national prevalence of stunting (an indicator of chronic malnutrition) among children under five has declined from 51% in 2004 to 36% in 2014. The malnutrition scenario in Sylhet Division is worse, which has the nation’s highest prevalence of stunting and the highest under-five mortality rate. Suchana, a large scale nutrition program to provide both nutrition specific and sensitive intervention packages, aims to achieve a significant reduction in the incidence of stunting among children under two years of age in Sylhet and Moulvibazar district of Sylhet Division. The project aims to serve 250,000 households of which 150,000 households would be poor and the remaining 100,000 households would be very poor. Suchana will work with and through Government of Bangladesh GoB, engage with the private sector, United Nations (UN) agencies and civil society platforms to pilot and test approaches that are replicable and scalable across the country to sustainably address under nutrition. Suchana program for poor and very poor households in rural Bangladesh is expected to prevent not only women and children undernutrition but also increase and diversification of income and reduce gender gaps and foster gender equality in the society. Studies are required to fill the evidence gap on the long term effect of Suchana intervention among targeted beneficiaries, changes in household dynamics, and empowerment in women due to participation through Suchana programme. Using a randomized controlled evaluation design this study will be able to demonstrate the effect of Suchana’s nutrition sensitive interventions in addition to nutrition specific interventions, which are known to be effective in reducing stunting.

Registration Citation:

Choudhary, N., 2019. Evaluation of the impact of Suchana on preventing chronic malnutrition: a cluster randomized trial. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie181

Categories:

Health, Nutrition, and Population

Additional Keywords:

nutrition sensitive, nutrition specific, intervention, pre-post study, stepped-wedge implementation

Secondary ID Number(s):

01368

Principal Investigator(s)

Name of First PI:

Nuzhat Choudhury

Affiliation:

icddr,b

Name of Second PI:

Affiliation:

Study Sponsor

Name:

Department for International Development (DFID)

Study Sponsor Location:

Bangladesh

Research Partner

Name of Partner Institution:

None

Type of Organization:

Location:

Bangladesh

Intervention

Intervention Overview

Intervention:

Suchana a large scale nutrition program, arrives at an opportune time to create momentum to strengthen nutrition governance in Bangladesh and will work with and through GoB, engage with the private sector, UN agencies and civil society platforms to test different activities that are replicable and scalable across the country to sustainably address under nutrition at national level to fulfil their commitments enshrined within key policies regarding nutrition specific and nutrition sensitive targets by strengthening capacity to design, manage and deliver nutrition focused programmes coherently and cost effectively. At the sub-national level, Suchana will provide technical support to build capacity of government frontline workers particularly those employed under Ministries of Health, Agriculture, Fisheries and Livestock using existing public sector systems and platforms to deliver Suchana activities. Suchana will also mobilize private sector actors to stimulate a viable market system to enhance economic opportunities for poor population in programme areas to address economic barriers to nutrition. With this dual and integrated approach, Suchana will play a catalytic role in strengthening the GoB’s ability to honour its commitment to significantly reduce stunting among children at the age of under two years. In total Suchana aims to serve around 250,000 households of which 150,000 households would be poor and the remaining 100,000 households would be very poor in 157 unions of Sylhet and Moulvibazar district. Suchana is expected to reduce stunting among children primarily. There are specific objectives of Suchana e.g. to increase economic accessibility as well as to create diversified source of income of the households, to improve IYCF and MNCH indicators and empowerment status of women and adolescents.

Theory of Change:

Given the complex and multi-dimensional nature of malnutrition in Bangladesh, in order to accelerate the rate of reduction in chronic malnutrition, there is a need to catalyse substantial changes in relation to both immediate and underlying factors that shape the nutritional landscape in Bangladesh. These changes can be categorised into five inter-related areas: (1) Improved nutrition governance that translates political commitments into practice; (2) Effective and inclusive government service delivery system that enhances access to and demand for nutrition-related services; (3) Economic empowerment of extreme poor and moderate poor people, particularly women and adolescent girls, so that they can overcome economic barriers to nutrition; (4) Adequate knowledge, skills and power particularly among women and adolescents girls to challenge harmful cultural practices and gender norms (including gender based violence, early marriage and early pregnancy)  that are required to ensure mother and child wellbeing and good nutrition (5) Robust evidence of a successful package of interventions to prevent chronic malnutrition in Sylhet division of Bangladesh that informs and galvanises a movement for change in policies and practices of  government and other actors at Sub-national  and National-levels.

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

Lead agency: Save the Children

Type of Organization:

NGO (International)

Program Funder

Name of Organization:

Department for International Development (DFID) and European Union (EU)

Type of Organization:

Foreign or Multilateral Aid Agency

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

02/01/2017

End Date:

12/31/2023

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Other (specify)

Other (not Listed) Method:

pre post evaluation

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

As subjects and households in 40 intervention unions will be compared with subjects and households in 40 control unions, all unions are randomly selected from a pool of around 157 unions, the design is a cluster randomized controlled trial of the effect of nutrition sensitive interventions on stunting and other outcomes. The main outcome indicator for Suchana evaluation is stunting among the age group 12-23 months. This age group is expected to have the highest prevalence of stunting. The evaluation of Suchana will consider two groups, the Suchana group comprised of Suchana beneficiaries who will get the interventions immediately after the baseline survey and a control group who shall not receive any interventions except the nutrition specific program provided by Government NNS services till the endline survey. The intervention group shall further be divided into two groups namely asset transfer group and non-asset transfer group. For the baseline survey, which will be conducted before the year 1 of the interventions, data shall be collected from 80 clusters; the 40 clusters of the “P1” programming and 40 clusters of the “P4” programming areas. From the same 80 clusters data shall be collected for the end line assessment just before commencement of the year 4 intervention.  The endline to baseline difference in outcome indicators in the 40 clusters of the “P4” programming areas shall assess the impact attributable to secular trend (not exposed to any of the interventions in the first 3 years). The end line to baseline difference in outcome indicators in the 40 clusters of the “P1” programming areas shall attribute for the full effect of Suchana.

Outcomes (Endpoints):

To assess the changes

• in the prevalence of stunting
• in the prevalence of exclusive breastfeeding in children 0-5 months old

• in the prevalence of optimal IYCF practices by mothers among children 6-23 months old (stratified into 6-11 months and 12-23 months group)
• in haemoglobin concentration of children aged between 12-23 months
• in the nutritional and social behaviour indicators of the household (HH) members
• in the increase and diversification of income of households
• in the Maternal Neonatal and Child Health (MNCH) indicators
• in women and adolescent (both male and female) empowerment

Unit of Analysis:

household

Hypotheses:

The prevalence of stunting will be significantly lower among children whose households benefit from Suchana in comparison to households in the control group who did not receive Suchana interventions.

Unit of Intervention or Assignment:

cluster - unions, which is the lowest administrative unit in Bangladesh

Number of Clusters in Sample:

80

Number of Individuals in Sample:

18600

Size of Treatment, Control, or Comparison Subsamples:

Control: 3920+3920 = 7840, Intervention: 3920+6640 = 10560

Supplementary Files

Analysis Plan:

Other Documents:

Data

Outcomes Data

Description:

Household survey

Data Already Collected?

No

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 1: Data for measuring impacts have not been collected

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

Unit of Analysis:

Clusters in Final Sample:

Total Observations in Final Sample:

Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:

Preliminary Report URL:

Summary of Findings:

Paper:

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Survey Instrument Links or Contact:

Program Files:

Program Files Links or Contact:

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: