Rojiroti microfinance and child nutrition: a cluster randomised trial

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

Abstract

Objective: To determine whether Rojiroti microfinance, for poor Indian women, improves child nutrition.

Design: Cluster randomised trial.

Setting: Tolas (village communities) in Bihar State.

Participants: Women and children under 5 years.

Interventions: With Rojiroti microfinance, women form self-help groups and save their money to provide loans to group members. After 6 months, they receive larger external loans. Tolas were randomised to receive Rojiroti immediately or after 18 months.

Outcome measures: The primary analysis compared the mean weight for height Z score (WHZ) of children under 5 years in the intervention versus control tolas who attended for weight and height measurement 18 months after randomisation. Secondary outcomes were weight for age Z score (WAZ), height for age Z score, mid-upper arm circumference (MUAC), wasting, underweight and stunting.

Results: We randomised 28 tolas to each arm and collected data from 2469 children (1560 mothers) at baseline and 2064 children (1326 mothers) at follow-up. WHZ was calculated for 1718 children at baseline and 1377 (674 intervention and 703 control) at follow-up. At 18 months, mean WHZ was significantly higher for intervention (-1.02) versus controls (-1.37; regression coefficient adjusted for clustering β=0.38, 95% CI 0.16 to 0.61, p=0.001). Significantly fewer children were wasted in the intervention group (122, 18%) versus control (200, 29%; OR=0.46, 95% CI 0.28 to 0.74, p=0.002). Mean WAZ was better in the intervention group (-2.13 vs -2.37; β=0.27, 95% CI 0.11 to 0.43, p=0.001) as was MUAC (13.6 cm vs 13.4 cm; β=0.22, 95% CI 0.03 to 0.40, p=0.02). In an analysis adjusting for baseline nutritional measures (259 intervention children and 300 control), only WAZ and % underweight showed significant differences in favour of the intervention.

Conclusion: In marginalised communities in rural India, child nutrition was better in those who received Rojiroti microfinance, compared with controls.

Trial registration number: NCT01845545.

Keywords: child growth; low & middle income countries; microfinance; wasting; weight for height z score.

Conflict of interest statement

Competing interests: GY is a Trustee of Rojiroti UK. SC is CEO of the Centre for Promoting Sustainable Livelihood.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
The state of Bihar, showing Patna district, with the participating administrative blocks (‘tehsils’) of Dulhin Bazar, Naubatpur, Masurhi and Bikram.
Figure 2
Figure 2
CONSORT diagram for cluster randomised controlled trial of the Rojiroti microfinance programme showing the number of children contributing to the primary outcome (WHZ) at 18 months. WHZ, weight for height Z score.
Figure 3
Figure 3
Use of loans by women in the intervention tolas, showing % of loans granted (A) and total amount borrowed in each category (B).

References

    1. UNICEF, WHO, World Bank Group Joint child malnutrition estimates. levels and trends in child malnutrition, 2016. Available: [Accessed Feb 2018].
    1. Black RE, Allen LH, Bhutta ZA, et al. . Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet 2008;371:243–60.10.1016/S0140-6736(07)61690-0
    1. United Nations - Sustainable Development knowledge platform Transforming our world: the 2030 agenda for sustainable development. Available: [Accessed Feb 2018].
    1. WHO Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition, 2013. Available: [Accessed Feb 2018].
    1. World Health Organization Commission on social determinants of health final report, 2006. Available: [Accessed Feb 2018].
    1. Subramanyam MA, Kawachi I, Berkman LF, et al. . Is economic growth associated with reduction in child undernutrition in India? PLoS Med 2011;8:e100042410.1371/journal.pmed.1000424
    1. Naandi Foundation The HUNGaMA fighting hunger and nutrition survey report. Hyderabad, India, 2011. Available: [Accessed Feb 2018].
    1. Yaron G, Kelly B, Choudhary S, et al. . Innovative microfinance for the very poor: assessing the impact of the Rojiroti approach. Harpenden: Rojiroti UK, 2011. Available: [Accessed Feb 2018].
    1. Ojha S, Szatkowski L, Sinha R, et al. . 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. Trials 2014;15:29810.1186/1745-6215-15-298
    1. Campbell MK, Piaggio G, Elbourne DR, et al. . Consort 2010 statement: extension to cluster randomised trials. BMJ 2012;345:e566110.1136/bmj.e5661
    1. Weijer C, Grimshaw JM, Eccles MP, et al. . The Ottawa statement on the ethical design and conduct of cluster randomized trials. PLoS Med 2012;9:e100134610.1371/journal.pmed.1001346
    1. International Institute for Population Sciences National family health survey (NFHS-4), India 2015-16, Bihar. Mumbai, 2016. Available: [Accessed Feb 2018].
    1. Cole TJ, Cortina Borja M. Optimal treatment of replicate measurements in anthropometric studies. Annals of Human Biology 2016;43:492.
    1. NutriSurvey Software for emergency nutrition assessment, 2011. Available: [Accessed Feb 2018].
    1. WHO WHO child growth standards and the identification of severe acute malnutrition in infants and children. A Joint Statement by the World Health Organization and the United Nations Children’s Fund, 2009. Available: [Accessed Feb 2018].
    1. Caulfield LE, Huffman SL, Piwoz EG. Interventions to improve intake of complementary foods by infants 6 to 12 months of age in developing countries: impact on growth and on the prevalence of malnutrition and potential contribution to child survival. Food Nutr Bull 1999;20:183–200.10.1177/156482659902000203
    1. Hayes RJ, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol 1999;28:319–26.10.1093/ije/28.2.319
    1. Orton L, Pennington A, Nayak S, et al. . Group-Based microfinance for collective empowerment: a systematic review of health impacts. Bull World Health Organ 2016;94:694–704.10.2471/BLT.15.168252
    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;40:2249–62.10.1016/j.worlddev.2012.03.012
    1. Duvendack M, Palmer-Jones R, Copestake J, et al. . 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. Available: [Accessed Feb 2018].
    1. Banerjee A, Duflo E, Glennerster R, et al. . The miracle of microfinance? Evidence from a randomized evaluation. Am Econ J Appl Econ 2015;7:22–53.10.1257/app.20130533
    1. Khatun M, Stenlund H, Hörnell A. Brac initiative towards promoting gender and social equity in health: a longitudinal study of child growth in Matlab, Bangladesh. Public Health Nutr 2004;7:1071–9.10.1079/PHN2004652
    1. Jalal CSB, Frongillo EA. Effect of poverty reduction program on nutritional status of the extreme poor in Bangladesh. Food Nutr Bull 2013;34:402–11.10.1177/156482651303400405
    1. MkNelly B, Dunford C. Impact of credit with education on mothers and their young children’s nutrition. California: University of California, Davis, 1998. Available: [Accessed Feb 2018].
    1. Moseson H, Hamad R, Fernald L. Microcredit participation and child health: results from a cross-sectional study in Peru. J Epidemiol Community Health 2014;68:1175–81.10.1136/jech-2014-204071
    1. Doocy S, Teferra S, Norell D, et al. . Credit program outcomes: coping capacity and nutritional status in the food insecure context of Ethiopia. Soc Sci Med 2005;60:2371–82.10.1016/j.socscimed.2004.10.025
    1. National food security mission Crop Calendar Bihar. Ministry of Agriculture & Farmers’ Welfare Government of India. Available: [Accessed Feb 2018].
    1. Nabwera HM, Fulford AJ, Moore SE, et al. . Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study. Lancet Glob Health 2017;5:e208–16.10.1016/S2214-109X(16)30355-2
    1. Saville NM, Shrestha BP, Style S, et al. . Impact on birth weight and child growth of participatory learning and action women's groups with and without transfers of food or cash during pregnancy: findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal. PLoS One 2018;13:e019406410.1371/journal.pone.0194064

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