Feasibility and pilot study of the effects of microfinance on mortality and nutrition in children under five amongst the very poor in India: study protocol for a cluster randomized controlled trial

Shalini Ojha, Lisa Szatkowski, Ranjeet Sinha, Gil Yaron, Andrew Fogarty, Stephen Allen, Sunil Choudhary, Alan R Smyth, Shalini Ojha, Lisa Szatkowski, Ranjeet Sinha, Gil Yaron, Andrew Fogarty, Stephen Allen, Sunil Choudhary, Alan R Smyth

Abstract

Background: The United Nations Millennium Development Goals include targets for the health of children under five years old. Poor health is linked to poverty and microfinance initiatives are economic interventions that may improve health by breaking the cycle of poverty. However, there is a lack of reliable evidence to support this. In addition, microfinance schemes may have adverse effects on health, for example due to increased indebtedness. Rojiroti UK and the Centre for Promoting Sustainable Livelihood run an innovative microfinance scheme that provides microcredit via women's self-help groups (SHGs). This pilot study, conducted in rural Bihar (India), will establish whether it is feasible to collect anthropometric and mortality data on children under five years old and to conduct a limited cluster randomized trial of the Rojiroti intervention.

Methods/design: We have designed a cluster randomized trial in which participating tolas (small communities within villages) will be randomized to either receive early (SHGs and microfinance at baseline) or late intervention (SHGs and microfinance after 18 months). Using predesigned questionnaires, demographic, and mortality data for the last year and information about participating mothers and their children will be collected and the weight, height, and mid upper arm circumference (MUAC) of children will be measured at baseline and at 18 months. The late intervention group will establish SHGs and microfinance support at this point and data collection will be repeated at 36 months.The primary outcome measure will be the mean weight for height z-score of children under five years old in the early and late intervention tolas at 18 months. Secondary outcome measures will be the mortality rate, mean weight for age, height for age, prevalence of underweight, stunting, and wasting among children under five years of age.

Discussion: Despite economic progress, marked inequalities in child health persist in India and Bihar is one of the worst affected states. There is a need to evaluate programs that may alleviate poverty and improve health. This study will help to inform the design of a definitive trial to determine if the Rojiroti scheme can improve the nutrition and survival of children under five years of age in deprived rural communities.

Trial registration: Clinicaltrials.gov (study ID: NCT01845545). Registered on 24 April 2013.

Figures

Figure 1
Figure 1
Study site. The study is being conducted in the Patna district in Bihar, India.

References

    1. Engels F. The Condition of the Working Class in England. Leipzig: Otto Wigand; 1845.
    1. Commission on Social Determinants of Health Final Report Geneva: World Health Organization; 2006.
    1. Millenium development goals and beyond 2015 UN Web Services Section, Department of Public Information, United Nations: New York, NY 10017, United States; []
    1. Khandkar S. Microfinance and poverty: evidence using panel data from Bangladesh. World Bank Rev. 2005;19:203–223. doi: 10.1093/wber/lhi011.
    1. Pitt MM, Khandker SR, Chowdhury OH, Millimet DL. Credit programs for the poor and the health status of children in rural Bangladesh. Int Econ Rev. 2003;44:87–118. doi: 10.1111/1468-2354.t01-1-00063.
    1. DeLoach SB, Lamanna E. Measuring the impact of microfinance on child health outcomes in Indonesia. World Dev. 2011;39:1808–1819. doi: 10.1016/j.worlddev.2011.04.009.
    1. Liu N, Iribarren S, Ciapponi A, Pearce P: Microfinance-based interventions for health outcomes in persons of low socioeconomic status (protocol).Cochrane Database Syst Rev 2011, (10):CD009393.
    1. Duvendack M, Palmer-Jones R, Copestake JG, Hooper L, Loke Y, Rao N. What is the evidence of the impact of microfinance on the well-being of poor people? London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London; 2011.
    1. Pronyk PM, Hargreaves JR, Morduch J. Microfinance programs and better health - prospects for sub-Saharan Africa. J Am Med Assoc. 2007;298:1925–1927. doi: 10.1001/jama.298.16.1925.
    1. Morduch J. Does Microfinance Really Help the Poor? New Evidence from Flagship Programs in Bangladesh. Santford CA, USA: Stanford University; 1998.
    1. Taylor M. ‘Freedom from poverty is not for free’: rural development and the microfinance crisis in Andhra Pradesh, India. J Agrar Change. 2011;11:484–504. doi: 10.1111/j.1471-0366.2011.00330.x.
    1. van Rooyen C, Stewart R, de Wet T. The impact of microfinance in sub-saharan africa: a systematic review of the evidence. World Dev. 2012;40:2249–2262. doi: 10.1016/j.worlddev.2012.03.012.
    1. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. Br Med J. 2000;321:694–696. doi: 10.1136/bmj.321.7262.694.
    1. Haase D. Banking on the poor. Contexts. 2012;11:36–41. doi: 10.1177/1536504212436494.
    1. Indian Grameen Service . Report on Assessment of “ROJIROTI” INITIATIVE by Centre for Promoting Sustainable Livelihood (CPSL) Kolkota India: Indian Grameen Service; 2009.
    1. RojiRoti UK 32 Amenbury Lane, Harpenden, UK, AL5 2DF []
    1. Government of India . Volume 2013. New Delhi, India: Ministry of Statistics and Programme Implimentation, Government of India; 2012. Statistical Year Book, India 2012.
    1. Panagariya A, Mukim M. A comprehensive analysis of poverty in India. Asian Dev Rev. 2014;31:1–52. doi: 10.1162/ADEV_a_00021.
    1. World Health Organization . WHO child growth standards and the identification of severe acute malnutrition in infants and children. Geneva: World Health Organization; 2009.
    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–260. doi: 10.1016/S0140-6736(07)61690-0.
    1. Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999;28:319–326. doi: 10.1093/ije/28.2.319.
    1. Government of India: International Institute for Population Sciences Deemed University Mumbai . Nutritional status of children and prevalence of anaemia among children, adolescent girls and pregnant women. New Dehli: Ministry of Health and Family Welfare, Government of India; 2006.
    1. Tarwa C, De Villiers FPR. The use of the Road to Health Card in monitoring child health. Fam Pract. 2007;49:15a–15d.
    1. ENA for SMART 2011 Software for Emergency Nutrition Assessment []
    1. REACH project Nottingham, United Kingdom: University of Nottingham; []
    1. Tarozzi A. Some facts about boy versus girl health indicators in India: 1992–2005. Cesifo Econ Stud. 2012;58:296–321. doi: 10.1093/cesifo/ifs013.
    1. Cobham A, Molina N, Garde M. The Child Development Index 2012: Progress. London, UK: Challenges and Inequality. Save the Children; 2012.
    1. The World Bank: Data []. 1818 High Street, NW, Washington, DC 20433, USA
    1. HUNGaMA . Fighting Hunger and Malnutrition. India: Nandi Foundation, Hyderabad; 2011.
    1. Rajan K, Kennedy J, King L. Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India. Soc Sci Med. 2013;88:98–107. doi: 10.1016/j.socscimed.2013.04.004.
    1. Balarajan Y, Selvaraj S, Subramanian SV. India: towards universal health coverage, health care and equity in India. Lancet. 2011;377:505–515. doi: 10.1016/S0140-6736(10)61894-6.

Source: PubMed

3
Tilaa