Maternal and child nutritional adequacy Other
Conditions
Interventions
An integrated intervention involving rural food markets (haats), communities, and families will be tested. 60 markets and associated village clusters will be randomly allocated to two trial arms, givi
Sponsors
London School of Hygiene & Tropical Medicine
Eligibility
Sex/Gender
All
Age
0 Months to 49 Years
Inclusion criteria
Inclusion criteria: For participation in interventions: Haat-village clusters come from four blocks (Patna, Keonjhar, Harichandanpur and Ghatgaon blocks) in Keonjhar district, Odisha. Eligible markets are those that run weekly, are leased by the government (Gram Panchayat), have a minimum of 10 vendors selling nutrient-dense foods on average over the year (minimum of 8 at any given time), and are not a block headquarter market. The village cluster associated with each market is a randomly selected village that is primarily served by the market. Residential areas (e.g. villages and surrounding hamlets) are combined to give an expected minimum of 800 population per village cluster. In the intervention arm, all women and men are eligible to participate in the monthly participatory groups and the market activities, and all families with a child aged 0-35 months at baseline are eligible to receive videos sent via smartphones and accompanying home visits. For primary outcomes: 1. Children (one 'index child' per household) aged 0-35 months at baseline, with a mother / female primary caregiver who is aged 18-49 years and has no discernible disability preventing them from participating in the surveys. Note that dietary recalls are not conducted for children aged 0-5 completed months, but are conducted for these children at endline. 2. Mother or primary female caregiver of the index child, aged 18-49 years, with no discernible disability preventing them from participating in the surveys. For the secondary outcome: 1. The father of the index child, or otherwise an adult male decision-maker living in the household, aged >=18 years, with no discernible disability preventing them from participating in the surveys.
Exclusion criteria
Exclusion criteria: Clusters: 1. Markets that do not have a minimum of 10 vendors of nutrient-dense foods over the year (or fewer than 8 at any given time of year). 2. Markets that are not leased by the Gram Panchayat. 3. Markets that are located in the block headquarters. 4. Markets that are in close proximity to neighbouring markets. 5. Village clusters that are served by multiple markets. 6. Village clusters that are small (600 households). Trial participants (for evaluation): 1. Any primary female caregiver who does not have a child aged 0-35 months at baseline. 2. Any primary female caregiver who has a discernible disability preventing them from participating in the surveys. 3. Any primary caregiver or male respondent who is not defined as a 'household member'. That is, primary caregivers who have not resided in the household regularly at least half of the time during the past 12 months (e.g. 3-4 days of each week for 12 months, or 6 full months of past 12 months), unless they joined the household through marriage less than 12 months ago. Residing means living in the households and eating from the same pot. A married mother/father who is temporarily visiting their natal home, and so has not lived at the natal home for the past 12 months, will not be included. Household members do include servants, lodgers, and agricultural labourers currently in the household who will be staying in the household for a longer period, even if they arrived fewer than 12 months ago. 4. Any primary caregiver aged under 18 or over 49 completed years. 5. Any male respondent aged under 18 completed years.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Child nutrient adequacy measured longitudinally, using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). Children are aged 0-35 months at baseline and 24-59 months by endline. Diets are not measured at baseline if children are aged 0-5 completed months. 2. Maternal nutrient adequacy measured longitudinally, using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). Respondents are the mother or primary female caregiver of the index child, and are aged 18-49 years. Diets are assessed using 24-hour dietary recall, with repeat measures on 10% of the sample. Food intakes are linked to nutritive values using a compiled Food Composition Table. Repeat measures are used to account for within-person variance in diets, predicting usual nutrient intakes as the Best Linear Unbiased Predictor of observed intakes. Mean micronutrient adequacy will be calculated for a mean of 11 priority nutrients (iron, zinc, calcium, vitamin A, vitamin C, thiamin, riboflavin, niacin, B6, folate, B12). For each nutrient, adequacy will be calculated as: intake / Recommended Nutrient Intake *100, capped at 100. The mean of these individual nutrient adequacies across the 11 nutrients will give our summary adequacy score. Nutrient adequacy scores range from 0-100. Baseline will run from Dec 2025-Jan 2026, and endline from Dec 2027-Jan 2028. | — |
Secondary
| Measure | Time frame |
|---|---|
| Men's nutrient adequacy, measured longitudinally using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). Adequacy is calculated in the same way as the primary outcomes. Respondents are the father of the index child, or another adult male decision-maker if the father is not available. Men's adequacy will not be assessed if there are no adult men living in the household. Other outcomes of interest: 1. Mothers' consumption of perishable nutrient-dense foods (g/d) measured using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). 2. Children's consumption of perishable nutrient-dense foods (g/d) measured using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). 3. Global Diet Quality Score for mothers / caregivers, measured using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). 4. Global Diet Quality Score for children, measured using 24-hour dietary recalls at endline only (24 months after baseline). 5. Women’s share of total adult nutritional adequacy (women / women + men), measured using 24-hour dietary recalls at baseline (before the intervention begins) and endline (24 months after baseline). 6. Men’s willingness-to-pay for nutrient-dense foods, measured using a structured questionnaire at baseline (before the intervention begins) and endline (24 months after baseline). Willingness-to-pay measures are pooled and normalised across goods. 7. Women's willingness-to-pay for nutrient-dense foods, measured using a structured questionnaire at baseline (before the intervention begins) and endline (24 months after baseline). Willingness-to-pay measures are pooled and normalised across goods. 8. Intra-household cooperation score, measured using a composite score (on discussion, joint decision-making, and information sharing around food choices | — |
Countries
India
Contacts
Public ContactHelen Harris-Fry
Outcome results
None listed