Abstract
BackgroundChild health, nutrition, and responsive stimulation interventions have been developed to improve child survival, growth and development outcomes in low- and middle-income countries. Nevertheless, research on integrated implementation approaches to deliver and promote uptake of these interventions is needed, particularly in sub-Saharan Africa.Methods/designWe will conduct a cluster-randomized controlled trial of a supply-side community health worker (CHW) delivered child health, nutrition, and responsive stimulation intervention alone and in combination with a demand-side conditional cash transfer (CCT) intervention to promote antenatal care and child growth monitoring attendance in rural Morogoro region, Tanzania. Twelve village clusters will be randomly assigned to one of the three trial arms: (1) CHW, (2) CHW + CCT, or (3) Control. Mothers (or another primary caregiver) residing in study villages are eligible for trial enrollment if they are currently pregnant or have a child < 1 year of age at the time of enrollment. For the duration of the trial, CHWs will visit households once every 4–6 weeks to deliver the intervention package and CCTs will be provided for documented antenatal care and routine child health and growth monitoring clinic visits. Participants will be followed-up at 9 months (midline) and 18 months (endline) post-randomization. The primary outcomes of the trial are child development assessed by the Bayley Scales of Infant and Toddler Development (BSID-III) and child height-for-age z-score. Secondary outcomes include a range of maternal, child and household outcomes.DiscussionThis trial will provide evidence on the effect of CHWs and conditional cash transfers on child growth and development. The results of the trial may be generalizable to similar settings in sub-Saharan Africa.Trial registrationISRCTN10323949, Retrospectively registered on October 3, 2017.
Highlights
DiscussionThis trial will provide evidence on the effect of community health worker (CHW) and conditional cash transfers on child growth and development
Child health, nutrition, and responsive stimulation interventions have been developed to improve child survival, growth and development outcomes in low- and middle-income countries
We present the protocol for a cluster-randomized controlled trial of a supply-side community health worker (CHW) delivered health, nutrition, and responsive stimulation intervention alone and in combination with a demand-side conditional cash transfer (CCT) intervention to promote antenatal care and routine child growth monitoring visit attendance in rural Tanzania
Summary
Sustainable Development Goal 4.2 calls for all countries to ensure that all girls and boys have access to quality early childhood development, care and pre-primary education by 2030 [29]. In order to address this call, we designed the current trial to examine the effect of a supply-side CHW interventions alone and in combination with a demandside CCT intervention. The primary outcomes of the trial will be child development and child linear growth and we have included a range of maternal, child, and household secondary outcomes. This trial will contribute to the growing literature on integration of child health, nutrition, and responsive stimulation and social protection programs, in the context of subSaharan Africa where the evidence is sparse.
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