Abstract
BackgroundThe Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial.MethodsSixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children’s Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children’s ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders.DiscussionAssessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes.Trial registrationISRCTN registry, ID: ISRCTN96497560. Registered on 21 September 2016.
Highlights
The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi
The potential for additive and synergistic effects of combining Early Childhood Health and Development (ECD), and nutrition, and agriculture and nutrition is clear [1]. Combining these three sectors may lead to substantial gains in cost, efficiency and effectiveness but these need to be rigorously evaluated
The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is designed to evaluate the impact of an integrated package of nutritional and agricultural interventions on the diets, nutrition and development of young children and their households in rural areas of Malawi
Summary
The proposed intervention package can potentially have an impact on the nutrition and health of children enrolled in CBCCs and their younger siblings, as summarised in Fig. 3 in the Appendix This involves a combination of direct transfers to the CBCC children (e.g. transfer of nutritious food through preschool meals) and indirect channels involving the behaviour-change campaigns promoting the consumption of nutritious foods and improved nutrition practices at household level. Addressing micronutrient deficiencies can improve a range of health, nutritional and developmental outcomes in infants and young children, if implemented alongside behaviour change on health and nutritional practices [17] This framework suggests that the emphasis of the interventions in the short term should focus on integrating nutritional education and messaging, alongside the CBCC meals, to deliver improved intake of micronutrient-rich foods, with the potential of leading to improved household diets. During the MDAT training all enumerators will be reviewed for consistency and reliability
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
