Acceptability of Health Care, Diet; Deficiency, Empowerment, Gender Equality, Stunting
Conditions
Keywords
nutrition, gender equity, health services, sexual and reproductive rights, dietary diversity, anthropometry, sexual and reproductive health services, WASH
Brief summary
This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. The evaluation will collect baseline, midline, and end-line data from intervention communities, schools, and health facilities. Only baseline and endline will be collected on the comparison communities. The evaluation objectives are to test if the intervention improved indicators for (i) child anthropometry, (ii) maternal and child dietary practices, (iii) women's empowerment, and (iv) equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators.
Detailed description
This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention ("Realizing Gender Equality, Attitudinal Change and Transformative Systems in Nutrition", REACTS-IN) to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. REACTS-IN is a multi-sectoral approach, integrating nutrition-related determinants, such as water, sanitation, and hygiene (WASH) interventions and health systems strengthening, to improve access to quality and gender-responsive health systems with increased capacity to prevent and treat malnutrition, especially at the primary health care level. REACTS-IN includes both nutrition-specific (e.g., school-based iron-folic acid supplement program) and nutrition-sensitive (e.g., WASH education) activities delivered through local health systems and/or schools, and communities. This independent evaluation will include three data collection at baseline, midpoint, and end-line to evaluate the performance indicators for the ultimate and intermediate outcomes. This includes indicators for child anthropometry, maternal and child dietary practices, women's empowerment, and equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators. The data collection will be carried out with intervention communities as well as with comparison communities. The estimated household sample is 463 households (women, husbands, child)/arm/country per time point, selected through a multi-stage cluster sampling methodology. The household baseline survey with a representative sample of mothers with children (0-5.9 mo; 6-23.9 mo; 24-59.9 mo) will be compared to the values at midpoint (to assess initial impact and the need for program adjustments) and at end-line (to assess the total impact of the project). The surveys will include sociodemographic, economic, and environmental information to assess the indicators for the local context. The evaluation also includes a sample of 500 school-going adolescents (250 boys, 250 girls)/arm/country per time point to assess indicators of knowledge about nutrition, menstrual hygiene management, and sexual and reproductive health. Finally, a sample of approximately 24 health staff and community leaders will provide qualitative data on gender-equitable access to services per arm/country for baseline and end-line. Although the project also is working in Somalia, this independent evaluation does not include data collection in Somalia.
Interventions
BEHAVIORALEducation intervention on nutrition, gender equity, WASH, sexual and reproductive health rights
Educational training on nutrition, gender equity, WASH, sexual and reproductive health rights will take place in communities (including schools) for women, men, and adolescents
DIETARY_SUPPLEMENTschool-based iron-folic acid supplement program
The program will help support and promote the school-based programs of weekly iron and folic acid supplementation for adolescent girls, in countries where it is allowed.
BEHAVIORALHealth service training on equitable access to nutrition, health, and sexual and reproductive services
Training and support activities to make gender-equitable nutrition, health, and sexual and reproductive services in the health facilities
DIETARY_SUPPLEMENTbio-fortified crops
The program promotes and distributes bio-fortified crops, including orange-fleshed sweet potatoes, rice, beans, and corn
Sponsors
McGill University
World Vision Canada
Global Affairs Canada
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
This is a quasi-experimental design for the evaluation of an intervention that is in the community (including schools) as well as in the local health service facilities. The data collection at baseline, midline, and end-line will occur simultaneously in the intervention and comparison selected communities. Comparison communities will not be visited during midline. Participants are unique at each time point.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
(i)Women: * 15-49 y of age * biological mother of child in the home who is 0-5.9, 6-23.9, or 24-59.9 months * has lived in the community for at 12 months (ii) Husbands/partners: * no age limit * lives in the home with index woman * has lived in community for at least 12 months (iii) Adolescents: * 10-19 years * male or female * has been in target school for at least 6 months * lives in the target community (iv) Children: * 0-5.9, 6-23.9, or 24-59.9 months
Exclusion criteria
(i) Children: * no limitation on normal diet or growth (birth defects, illnesses)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gender equality | Change between baseline and study completion, an average of 5 years | Percent of households with children \< 59.9 mo that have achieved gender equality |
| Child anthropometry | Change between baseline and study completion, an average of 5 years | Percent of children 6-59 mo of age who are stunted |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Antenatal care | Change between baseline and study completion, an average of 5 years | Percent of mothers of children 0-6 months who attended at least four ante-natal visits during the last pregnancy from skilled health personnel |
| Contraception use by women and partners | Change between baseline and study completion, an average of 5 years | Percent of women aged 15-49 years married or in union, who are currently using, or whose sexual partner is using at least one modern contraception method |
| Child diet | Change between baseline and study completion, an average of 5 years | Percent of children 6-23.9 months of age, who receive minimum dietary diversity and minimum meal frequency |
| Sexual and reproductive health services for adolescents | Change between baseline and study completion, an average of 5 years | Percent of adolescent girls (10-19) who report that they were offered sexual and reproductive health services |
| Gender equitable health services for nutrition, health, and sexual and reproductive health | Change between baseline and study completion, an average of 5 years | Percent of health facilities promoting gender equitable and responsive nutrition, health, and sexual and reproductive services |
| Exclusive breastfeeding | Change between baseline and study completion, an average of 5 years | Percent of children 0-5.9 mo who are exclusively breastfed |
| Use of family planning | Change between baseline and study completion, an average of 5 years | Percent of women 15-49 y who decided to use family planning |
| adolescent knowledge of nutrition, menstrual hygiene, and sexual and reproductive health | Change between baseline and study completion, an average of 5 years | Percent of adolescent girls and boys with appropriate knowledge about nutrition, menstrual hygiene, and sexual and reproductive health |
| maternal knowledge on nutrition | Change between baseline and study completion, an average of 5 years | Percent of women 15-49 y with appropriate knowledge on good maternal nutrition |
| Attended birth deliveries | Change between baseline and study completion, an average of 5 years | Percent of deliveries attended by skilled birth personnel |
| maternal knowledge of family planning | Change between baseline and study completion, an average of 5 years | Percent of mothers who know at least 3 modern methods of family planning |
| maternal knowledge of exclusive breastfeeding | Change between baseline and study completion, an average of 5 years | Percent of mothers who know at least 3 benefits of exclusive breastfeeding |
| mothers planting biofortified crops | Change between baseline and study completion, an average of 5 years | Percent of mothers who have planted biofortified crops from REACTS-IN materials |
| mothers planting nutrient dense local vegetables | Change between baseline and study completion, an average of 5 years | Percent of mothers who have planted nutrient dense local vegetables from REACTS-IN seeds |
| mothers planting trees | Change between baseline and study completion, an average of 5 years | Percent of mothers who have planted fruit tress from REACTS-IN materials |
| hygenic toilets | Change between baseline and study completion, an average of 5 years | Percent of households with hygienic toilets |
| community health worker visit | Change between baseline and study completion, an average of 5 years | Percent of households that received at least one community health worker visit in last month |
| Adolescent iron folic acid supplements | Change between baseline and study completion, an average of 5 years | Percent of adolescent girls who received the recommended scheme of weekly iron-folic actic supplements |
| health facility | Change between baseline and study completion, an average of 5 years | Percent of health facilities scoring \> 80 on planning assessment |
Countries
Bangladesh, Kenya, Tanzania
Contacts
CONTACTGrace S Marquis, PhD
CONTACTAishat Abdu, PhD
PRINCIPAL_INVESTIGATORGrace S Marquis, PhD
McGill University
Outcome results
None listed