SPRING Cluster Randomised Controlled Trial (SPRING)

August 23, 2017 updated by: London School of Hygiene and Tropical Medicine

SPRING (for the Millennium Development Goals): Sustainable Programme Incorporating Nutrition and Games (for Maximising Development, Growth and Survival)

A large number of children in developing countries lack access to known effective interventions. Almost 9 million die each year before reaching their fifth birthday, and over 200 million children who survive fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. The goal of "SPRING", Sustainable Programme Incorporating Nutrition and Games, is to develop an innovative approach to close this access gap, in two of the worst affected countries India and Pakistan, using community based agents. Extensive formative research will be carried out to help ensure that the content and approach of the "SPRING" intervention is feasible, acceptable and appropriately targeted. Findings will be reviewed at an intervention development workshop with local and international stakeholders and experts, and the agreed intervention piloted with a few community based agents and their supervisors. Cluster randomised controlled trials will be carried out in each setting to evaluate the impact of "SPRING" on child growth, development and survival. The programme will include process and economic evaluations to provide information on the total cost of the intervention and its cost effectiveness, as well as development of a framework with lessons learned for implementing "SPRING" in other settings.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

The goal of "SPRING", Sustainable Programme Incorporating Nutrition and Games, is to develop an innovative, feasible, affordable and sustainable community based approach that can achieve delivery at scale of known effective interventions that will maximise child development, growth and survival. The vision is to do this by working in close collaboration with government programmes in India and Pakistan, and modifying the approach, content and supervision of existing community based programmes to develop an innovative intervention package that

  • Is designed from the outset to be feasible, affordable and appropriate for delivery at scale.

  • Is delivered by low cost community based agents through home visits from pregnancy through the first 2 years of life, which

    • promote evidence based newborn and child survival interventions
    • use a problem solving and counselling approach, rather than the standard didactic approach, using techniques informed by evidence from the cognitive behaviour and interpersonal psychotherapy fields.
    • teach care giving skills, such as early recognition of infant signals and capacity, enhancing mother baby interactions, providing stimulation for cognitive growth and development.
    • support optimal infant and young child feeding practices.
    • encourage participation of other family members, e.g. fathers and grandmothers.
    • is informed by the Care for Development Package developed by the World Health Organization (WHO) and the United Nations International Emergency Children's Fund.
  • Includes regular supervision, monitoring and evaluation to support the community based agents and ensure the quality of the intervention activities carried out.
  • Includes a range of supporting activities developed to provide an enabling environment for mothers and families to carry out the interventions and skills promoted. These might include, for example, community group meetings, and sensitisation sessions with health staff.

The specific objectives of "SPRING" are

  1. To test this intervention package through cluster randomised controlled trials in two settings, one in India and one in Pakistan, both with high rates of undernutrition and well established but somewhat different community based agent programmes.
  2. To evaluate the impact of the intervention on Infant mortality, child development and growth Maternal psychosocial distress. Coverage of key promoted interventions.
  3. To evaluate and monitor all aspects of the intervention process and implementation
  4. To cost the delivery of the intervention, and assess its cost effectiveness.
  5. To assess the effectiveness of the intervention in reducing inequities in trial outcomes.

Study Type

Interventional

Enrollment (Anticipated)

12000

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • India
    • Goa
      • Porvorim, Goa, India, 403501
        • Recruiting
        • Sangath: Haryana field site
        • Contact:
        • Principal Investigator:
          • Gauri Divan, MD
  • Pakistan
    • Punjab
      • Islamabad, Punjab, Pakistan, 44000
        • Not yet recruiting
        • Human Development Research Foundation: Rawalpindi field site
        • Contact:
        • Principal Investigator:
          • Siham Sikander, MD, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

1 day to 2 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • All liveborn babies whose mothers reside within the trial evaluation zones

Exclusion Criteria:

  • major congenital malformation
  • maternal death in neonatal period

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: SPRING intervention clusters

SPRING package: Home visits by community based agents carried out from pregnancy to 2 years of age to encourage key behaviours to promote child growth, survival and development together with regular supervision

PLUS access to routine maternal and child health services
Behavioral: SPRING
SPRING package: Home visits by community based agents carried out from pregnancy to 2 years of age to encourage key behaviours to promote child growth, survival and development together with regular supervision
Other Names:
  • Pakistan: Roshan Kal
  • India: Kilkaari (to be confirmed)
No Intervention: Control clusters
access to routine maternal and child health services

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
infant mortality
Time Frame: the first year of life
the % of newborns who die during the first year of life
the first year of life
stunting
Time Frame: 18-24 months
% children stunted, with stunting defined as below -2 standard deviations of height for age using the WHO growth standards
18-24 months
child development
Time Frame: 18-24 months of age
a range of psychometric outcome measures covering several domains including cognition, motor, language, and psychosocial development plus maternal-child interaction and quality of the home environment.
18-24 months of age
maternal psychosocial distress/depression
Time Frame: 6-12 months postpartum
assessed using the 9 item Patient Health Questionnaire
6-12 months postpartum

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
% adopting key promoted behaviours
Time Frame: from pregnancy up to age 2
from pregnancy up to age 2
wasting
Time Frame: 18-24 months of age
% children below -2 standard deviations for weight for height using the WHO growth standards.
18-24 months of age
underweight
Time Frame: 18-24 months of age
% children below the -2 standard deviations for weight for age using the WHO growth standards.
18-24 months of age
age-specific infant mortality
Time Frame: during the first year of life
% babies who die within the following periods after birth: <1 week, 1-3 weeks, 1st month,1-5 months, 6-11 months
during the first year of life

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

London School of Hygiene and Tropical Medicine

Collaborators

Sangath
University College, London
University of Liverpool
Human Development Research Foundation, Pakistan

Investigators

  • Principal Investigator: Betty Kirkwood, MSc, FMedSci, London School of Hygiene and Tropical Medicine

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2014

Primary Completion (Anticipated)

October 1, 2017

Study Completion (Anticipated)

October 1, 2017

Study Registration Dates

First Submitted

February 10, 2014

First Submitted That Met QC Criteria

February 10, 2014

First Posted (Estimate)

February 11, 2014

Study Record Updates

Last Update Posted (Actual)

August 24, 2017

Last Update Submitted That Met QC Criteria

August 23, 2017

Last Verified

August 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • EPNPBE2610
  • 093615 (Other Grant/Funding Number: Wellcome Trust)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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