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Stunting Prevention Project in Thatta and Sajawal Districts, Sindh Province, Pakistan

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ClinicalTrials.gov Identifier: NCT02422953
Recruitment Status : Active, not recruiting
First Posted : April 22, 2015
Last Update Posted : January 9, 2018
Sponsor:
Collaborators:
United Nations World Food Programme (WFP)
Pakistan Ministry of Health
Information provided by (Responsible Party):
Dr Sajid Bashir Soofi, Aga Khan University

Brief Summary:

Widespread food insecurity and malnutrition are largely the main impairing factors for human capital development in Pakistan. Rates of chronic malnutrition are very high, and acute malnutrition is critical: 44% of children under five are stunted and nationwide global acute malnutrition (GAM) rates amongst children under five exceed the WHO critical threshold of 15%. Nutritional status trends also show a deteriorating situation since 1994, when stunting rates were at 36%.

This study evaluates the effectiveness of food based interventions to prevent stunting among children under-five years with focus on window of opportunity (1000 days from conception to 2 years) for addressing stunting. Pregnant women, lactating mothers and children 6-59 months will receive supplements on monthly basis in intervention areas, while participants in control areas will receive routine public health services available in the study area.


Condition or disease Intervention/treatment Phase
Malnutrition Dietary Supplement: Wheat Soya Blend (WSB) Dietary Supplement: Wawa Mum Dietary Supplement: Micronutrient Powders (MNP) Behavioral: Behavior change and preventive health massages Not Applicable

Detailed Description:

Children under two are consuming less than half of their daily energy requirements (560 kcal) and lower than recommended levels of micronutrients (one-third of reference nutrient intake for Iron and one-half for Zinc). Overall, less than 4% of children were receiving an acceptable, diverse diet. Food security and nutrition situation in Sindh province is even more dramatic. According to the National Nutrition Survey, 2011, GAM prevalence exceeds 18% while anemia levels amongst children under five reached the alarming level of 72.5%. With this high level of poverty and food insecurity, a food based approach to prevent stunting, together with non- food based approaches is needed.

Therefore, Division of Women and Child Health, Aga Khan University proposes a research study for stronger evidence base on the effectiveness of preventive food/nutrient based interventions on reduction of stunting and developing viable programmes on nutrition under "real" operational conditions. The effectiveness of the project will be measured in terms of the impact of the proposed interventions on the stunting and micronutrient deficiency prevalences in the target group (children and mothers). Given the conditions of project implementation, a quasi-experimental "double difference" design would be appropriate to assess the impact of the intervention. We propose to compare the intervention and non-intervention (control) groups before (first difference) and after the intervention (second difference). Then, the operational implementation of the research comprises a baseline and end line surveys. In addition, a nested cluster randomized controlled trial will be implemented to track the evolution of key variables related to the quality of intervention delivery and intermediate nutrition outcomes. The control clusters will receive routine public and private health services available in the area.

To achieve its purpose and objectives the project design includes core interventions such as complementary feeding using food/nutrient based supplements along with behavior change communication, complemented with other non-food interventions. Using a preventative (blanket) approach, three types of food/nutrient supplements (Wawamum, MNP & WSB) are considered as part of the interventions.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6990 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Effectiveness of Food/Nutrient Based Interventions to Prevent Stunting Among Children Under Five in Thatta and Sajawal Districts, Sindh Province, Pakistan
Study Start Date : January 2014
Estimated Primary Completion Date : September 2018
Estimated Study Completion Date : September 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Intervention
Wheat Soya Blend, Wawa Mum, Micronutrient Powders, Behavior change and preventive health massages
Dietary Supplement: Wheat Soya Blend (WSB)
A monthly ration of 5 Kg of WSB will be given to pregnant women every month during pregnancy and lactating mothers for six months after giving birth

Dietary Supplement: Wawa Mum
Children 6-23 months of age will receive a daily ration of 50 gram of Wawa Mum during study period

Dietary Supplement: Micronutrient Powders (MNP)
Children 24-59 months of age will receive a sachet of MNP in alternate days

Behavioral: Behavior change and preventive health massages
Behavior change and preventive health massages will be delivered by lady health workers (LHWs) during monthly visits and in group meetings

No Intervention: Control
Control group will receive routine public and private health services available in the area.



Primary Outcome Measures :
  1. Stunting-reduction in stunted children in intervention group [ Time Frame: 2 Years ]
    To calculate HAZ scores the 2006 WHO growth reference will be used


Secondary Outcome Measures :
  1. Pregnancy out come [ Time Frame: 2 Years ]
    Reduction in low birth weight in newborns

  2. Mean change in weight-for-height z-score (WHZ) [ Time Frame: 2 Years ]
    To calculate WHZ scores the 2006 WHO growth reference will be used

  3. Mean change in weight-for-age z-score (WAZ) [ Time Frame: 2 Years ]
    To calculate WAZ scores the 2006 WHO growth reference will be used

  4. Improvement in infant and young child feeding (IYCF) indicators [ Time Frame: 2 Years ]
  5. Linear growth velocity (HAZ increment/month) [ Time Frame: 2 Years ]
    To calculate HAZ score the 2006 WHO growth reference will be used

  6. Mean hemoglobin concentration in children 6-59 months of age [ Time Frame: 2 Years ]
    Hemocue will be used to measure Hb concentration

  7. Prevalence of childhood anemia (Hb concentration<11g/dL) in children 6-59 months of age [ Time Frame: 2 Years ]
  8. Mean hemoglobin concentration in mothers [ Time Frame: 2 Years ]
    Hemocue will be used to measure Hb concentration

  9. Prevalence of maternal anemia (Hb concentration<12g/dL) [ Time Frame: 2 Years ]
  10. Maternal BMI [ Time Frame: 2 Years ]
    The change in BMI z-score over the intervention period



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Ages Eligible for Study:   6 Months to 59 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • All pregnant women
  • All lactating mothers (upto 6 months)
  • All children 6-23 months of age
  • All children 24-59 months of age

Exclusion Criteria:

  • Refuse to participate in the study
  • Having severe chronic disease

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02422953


Locations
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Pakistan
Aga Khan University
Karachi, Sindh, Pakistan, 74800
Sponsors and Collaborators
Aga Khan University
United Nations World Food Programme (WFP)
Pakistan Ministry of Health
Investigators
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Principal Investigator: Sajid B Soofi, FCPS Aga Khan University

Publications:
National Nutrition Survey (NNS), 2011. Planning Commission Planning and Development Division Government of Pakistan.
WFP (2012): Protracted Relief and Recovery Operations (PRRO). Pakistan 200250. Rome, Italy.
Horton, S. Opportunities for investments in nutrition in low-income Asia; 1999. Asian Development Review 17 (1, 2): 246-273.
Gorstein J, Sullivan KM, Parvanta I, Begin F. Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations. The Micronutrient Initiative (Ottawa) and the Centers for Disease Control and Prevention (Atlanta), May 2007.
Donner, A. and Klar, N. Design and Analysis of Cluster Randomization Trials in Health Research. Arnold, London; 2000

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Dr Sajid Bashir Soofi, Associate Professor, Aga Khan University
ClinicalTrials.gov Identifier: NCT02422953     History of Changes
Other Study ID Numbers: WFP-Thatta
First Posted: April 22, 2015    Key Record Dates
Last Update Posted: January 9, 2018
Last Verified: January 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Data are sharing with funding agency on 6-monthly basis

Keywords provided by Dr Sajid Bashir Soofi, Aga Khan University:
Stunting
Wasting
Underweight

Additional relevant MeSH terms:
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Malnutrition
Growth Disorders
Nutrition Disorders
Pathologic Processes
Micronutrients
Trace Elements
Nutrients
Growth Substances
Physiological Effects of Drugs