Leveraging an Existing Large-scale Safe Water Program to Deliver Nutrition Messages at a Low Marginal Cost

The investigators are seeking to overcome the dual challenges of under-nutrition and diarrhea using an existing safe water supply platform to deliver nutrition information to targeted groups in Western Kenya. Using a randomized evaluation, investigators will determine the impact on nutrition status and practices of delivering nutrition information. The evaluation results will enable Evidence Action to make strategic decisions regarding the potential scale-up of the combined program across Kenya.

Study Overview

• Status: Completed
• Conditions: Child Malnutrition
• Intervention / Treatment: Behavioral: Provision of information on safe water; Behavioral: Provision of information on safe water and child nutrition

Detailed Description

Evidence Action's Dispensers for Safe Water program currently provides access to safe water for two million people. The program would be able to leverage the existence of this service delivery platform to provide promoters with training on proper nutrition and methods for delivering these messages to target groups.

The intervention is a home visiting program that will provide nutrition advice on complementary feeding to households with children aged 6-24 months. Two types of home visits will be evaluated, a 'traditional visit mode' in which the child's mother receives the visit; and a 'couples visit mode' in which the promoter attempts to involve both the father and mother.

Households in the control group will also receive home visits by promoters but the content of the visit will be restricted to safe water. The same information on safe water will also be provided to households in the treatment group. Hence, the evaluation will measure the additional effect of providing nutrition information on top of information on safe water.

Promoters will provide advice on nutrition and food hygiene to target households, according to criteria established by Evidence Action. Following the Guiding Principles for Complementary Feeding of the Breastfed Child (PAHO/WHO 2003), the intervention will include information on the maintenance of breastfeeding, safe/hygienic preparation and storage of complementary foods, amount of complementary food needed, food consistency, meal frequency and energy density, nutrient content of complementary foods, and feeding after illness. The home visits will be modelled on the MaiMwana Infant Feeding intervention (http://www.maimwana.malawi.net/MaiMwana/Home.html) that has been taking place in Mchinji (Malawi) since 2005.

Households within the treatment group will be provided by a poster to hang in their dwellings with some basic information on nutrition. A random subset of households will be given a small poster in black and white, and the other subset of households will be give a larger color poster.

• Study Type: Interventional
• Enrollment (Actual): 1671
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Kenya
  • Busia County
    • Busia, Busia County, Kenya
      • Evidence Action

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 1 year (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Children will be included if they are between 0 and 18 months at baseline and live within the catchment area of a water point in which Evidence Action installs a chlorine dispenser

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Control; Provision of information on safe water	Behavioral: Provision of information on safe water; A promoter from Evidence Action will visit the household and provide information on safe water.
Experimental: Treatment traditional; Provision of information on safe water and child nutrition. The information will be targeted to the mother of the child aged between 6 and 24 months old.	Behavioral: Provision of information on safe water and child nutrition; A promoter from Evidence Action will visit the household and provide information on safe water, as well as child nutrition (including hygiene on food preparation and storage). Households will be given a poster to hang in their dwellings with basic nutrition information. The poster might be smaller and in black and white, or larger and in color.
Experimental: Treatment couple; Provision of information on safe water and child nutrition. The information will be targeted to the mother of the child aged between 6 and 24 months old, and her husband.	Behavioral: Provision of information on safe water and child nutrition; A promoter from Evidence Action will visit the household and provide information on safe water, as well as child nutrition (including hygiene on food preparation and storage). Households will be given a poster to hang in their dwellings with basic nutrition information. The poster might be smaller and in black and white, or larger and in color.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Height-for-age z-score	Up to 18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge of child nutrition issues measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
Child nutritional intake measured using a 7 day Food Frequency Questionnaire	Measured using a 7 day Food Frequency Questionnaire	Up to 18 months
Child's age when breastfeeding stops measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
A composite index of other anthropometric indicators (includes child's weight for age z-score, child's mid-upper arm circumference, and child's head circumference)	The composite index will include child's weight for age z-score, child's mid-upper arm circumference, and child's head circumference.	Up to 18 months
Probability that the child suffers from bipedal oedema		Up to 18 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Household food consumption measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
Household consumption measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
Total Chlorine Residual score		Up to 18 months
Labor supply measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
Time cooking on the day prior to the interview measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
Women's empowerment measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months
Probability of having a chat with a friend or acquaintance about food or nutrition measured using a structured questionnaire	Measured using a structured questionnaire. Having a chat in the last 3 days prior to the survey interview.	Up to 18 months
Probability of child suffering from diarrhea measured using a structured questionnaire	Measured using a structured questionnaire. Suffering from diarrhea in the last 7 days prior to the survey. Diarrhea is defined as having 3 loose stools in any one day and/or having blood in the stools at least once.	Up to 18 months
Hygiene practices measured using a structured questionnaire	Measured using a structured questionnaire	Up to 18 months

Collaborators and Investigators

• Sponsor: Marcos Vera Hernandez
• Collaborators: Evidence Action; MaiMwana
• Investigators: Principal Investigator: Marcos Vera-Hernandez, PhD, research fellow

Study record dates

Study Major Dates

• Study Start: May 1, 2015
• Primary Completion (Actual): June 1, 2017
• Study Completion (Actual): June 1, 2017

Study Registration Dates

• First Submitted: April 14, 2015
• First Submitted That Met QC Criteria: April 27, 2015
• First Posted (Estimate): April 28, 2015

Study Record Updates

• Last Update Posted (Actual): March 19, 2019
• Last Update Submitted That Met QC Criteria: March 17, 2019
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Keywords: Information provision
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition; Child Nutrition Disorders
• Other Study ID Numbers: 1827/006