Suaahara Impact Evaluation: End-line Survey

Suaahara's primary aim is to reduce the prevalence of stunting, wasting, and underweight among children under 5 years of age and to reduce the prevalence of anemia among women of reproductive age and children 6-59 months of age. For this, the program uses a multi-sectoral approach to achieve four key intermediate results: 1) improved household nutrition, sanitation, and health behaviors; 2) increased use of quality nutrition and health services by women and children; 3) improved access to diverse and nutrient-rich foods by women and children; and 4) accelerated roll-out of the Multi-Sectoral Nutrition Plan (MSNP) through strengthened local governance

Study Overview

• Status: Completed
• Conditions: Feeding Behavior; Nutritional Stunting
• Intervention / Treatment: Behavioral: Health and family planning; Behavioral: Nutrition; Behavioral: Agriculture and homestead food production; Behavioral: Water, sanitation, and hygiene

Detailed Description

The Government of Nepal and development partners have prioritized multi-sectoral (integrated) nutrition as a key development agenda. The Suaahara program funded by the United States Agency for International Development is one of the programs that support the Government of Nepal's multi-sectoral nutrition plan. It aims to reduce maternal and child under-nutrition over a period of ten years, spanning two phases: Suaahara I (2011-2016) and Suaahara II (2016-2021). Initially launched in 20 of 75 districts, the program has scaled-up to 42 of 77 districts that span across Nepal's three agroecological zones of mountains, hills, and terai.

Suaahara I was led by Save the Children International in partnership with Helen Keller International, Johns Hopkins University Center for Communications Programs, Jhpiego, Nepal Water for Health (NEWAH), the National Promotion and Consultancy Service, and the Nepali Technical Assistance Group (NTAG). Suaahara II was led by Helen Keller International in partnership with Cooperative for Assistance and Relief Everywhere, Inc., Family Health International 360), he Nepali Technical Assistance Group, Digital Broadcast Initiative Equal Access, Environmental and Public Health Organization, and Vijaya Development Resource Center.

Suaahara's primary aim is to reduce the prevalence of stunting, wasting, and underweight among children under 5 years of age and to reduce the prevalence of anemia among women of reproductive age and children 6-59 months of age. For this, the program uses a multi-sectoral approach to achieve four key intermediate results (IRs): 1) improved household nutrition, sanitation, and health behaviors; 2) increased use of quality nutrition and health services by women and children; 3) improved access to diverse and nutrient-rich foods by women and children; and 4) accelerated roll-out of the MSNP through strengthened local governance. Suaahara interventions span health and family planning (FP), nutrition, agriculture/homestead food production (HFP), and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors. Suaahara's conceptual framework illustrates the paths by which the program activities linked to desired outcomes achieve Suaahara II objectives.

• Study Type: Interventional
• Enrollment (Actual): 2480
• Phase: Phase 3

Contacts and Locations

Study Locations

• Nepal
  • Kathmandu, Nepal
    • Helen Keller International

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 second to 5 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• At the household level, the primary respondents are mothers of children under 5 years of age from the selected households.
• Other survey respondents include a primary male (or female, if male unavailable) household decision-maker, and a grandmother of children under 5 years of age residing in the household.
• The Female Community Health Volunteer and health workers are also Suaahara beneficiaries, as the program explicitly aims to improve their knowledge and skills.

Exclusion Criteria:

• None.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; Suaahara interventions span health and family planning; nutrition; agriculture/homestead food production; and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors.	Behavioral: Health and family planning; Promotion of health and family planning behaviors; Behavioral: Nutrition; Promotion of maternal, infant, and young child feeding behaviors and nutrition; Behavioral: Agriculture and homestead food production; Promotion of knowledge and practices about homestead food production; Behavioral: Water, sanitation, and hygiene; Promotion of behaviors to improve water, sanitation, and hygiene
No Intervention: Comparison; Usual care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child dietary diversity (Indicators for Assessing Infant and Young Child Feeding Practices)	Mean score, range 0 to 8, higher is better	Over the 24 hours of the day before data collection
Maternal dietary diversity (Minimum Dietary Diversity for Women)	Mean score, range 0 to 10, higher is better	Over the 24 hours of the day before data collection
Stunting	Prevalence of height or length for age zscore < -2	Over the 24 hours of the day of data collection
Underweight prevalence	Prevalence of weight for age zscore < -2	Over the 24 hours of the day of data collection
Wasting	Prevalence of weight for length for height zscore < -2	Over the 24 hours of the day of data collection
Maternal underweight	Prevalence of body mass index < 18.5	Over the 24 hours of the day of data collection
Maternal anemia	Prevalence < 12 g/dl	Over the 24 hours of the day of data collection
Anemia among children aged 6-59 months	Prevalence < 11 g/dl	Over the 24 hours of the day of data collection
Accurate health, nutrition, and water, sanitation, and hygiene knowledge and skills among Female Community Health Volunteers and health workers from 52 items	Prevalence > 80% correct from 52 items	Over the 24 hours of the day of data collection

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child minimum dietary diversity (Indicators for Assessing Infant and Young Child Feeding Practices)	Prevalence > 4 food groups of 8	Over the 24 hours of the day before data collection
Maternal minimum dietary diversity (Minimum Dietary Diversity for Women)	Prevalence > 4 food groups of 10	Over the 24 hours of the day before data collection
Height for age	Mean z-score	Over the 24 hours of the day of data collection
Weight for age	Mean z-score	Over the 24 hours of the day of data collection
Weight for height	Mean z-score	Over the 24 hours of the day of data collection
Maternal body mass index	Mean	Over the 24 hours of the day of data collection
Maternal hemoglobin	Mean in g/dl	Over the 24 hours of the day of data collection
Child hemoglobin	Mean in g/dl	Over the 24 hours of the day of data collection
Knowledge score on core infant and young child feeding practices among mothers from 15 items	Mean score, range 0 to 15, higher is better	Over the 24 hours of the day of data collection
Knowledge score on health and water, sanitation, and hygiene practices among mothers from 37 items	Mean score, range 0 to 37, higher is better	Over the 24 hours of the day of data collection
Female Community Health Volunteers and health workers with ideal practices related to health, nutrition, and water, sanitation, and health from 52 items	Prevalence > 80% correct from 52 items	Over the 24 hours of the day of data collection

Collaborators and Investigators

• Sponsor: University of South Carolina
• Collaborators: Helen Keller International
• Investigators: Principal Investigator: Edward A Frongillo, PhD, University of South Carolina

Study record dates

Study Major Dates

• Study Start (Actual): June 17, 2022
• Primary Completion (Actual): September 30, 2022
• Study Completion (Actual): September 30, 2022

Study Registration Dates

• First Submitted: June 16, 2022
• First Submitted That Met QC Criteria: July 2, 2022
• First Posted (Actual): July 7, 2022

Study Record Updates

• Last Update Posted (Estimate): January 6, 2023
• Last Update Submitted That Met QC Criteria: January 4, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Growth Disorders
• Other Study ID Numbers: 103

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No