Abstract
BackgroundIn Pakistan, the prevalence of stunting in children younger than 5 years has remained above global critical levels over the past two decades, with the stunting rate being 40.2% in 2018. Children living in rural areas and in the poorest households suffer the most from stunting across the country—43.2% in rural areas and 51.4% in the lowest wealth quintile. As a continuing public health concern, it is essential that stunting prevention is a national priority in order to ensure human capital development, especially among the poorest households.ObjectiveThe primary objective of this study is to determine the effect of a medium quantity of a lipid-based nutrient supplement (LNS) combined with unconditional cash transfers and social and behavior change communication (SBCC) on reduction of stunting in children aged 6 to 23 months.MethodsA 5-arm cluster randomized controlled trial will be conducted in the district of Rahim Yar Khan in Punjab, Pakistan. The intervention packages will be (1) cash only, (2) cash with LNS, (3) cash with SBCC, and (4) cash with SBCC and LNS. The control arm will receive routine standard of care. We will enroll children at 6 months of age and follow up on a monthly basis up to 24 months of age. A total of 2000 children, 400 in each arm, will be enrolled to detect a 20% reduction in the prevalence of stunting among children aged 24 months. Length, weight, food intake, compliance to interventions, morbidities, and other relevant data will be collected at enrollment and on a monthly basis over the period of 18 months. The process evaluation will assess acceptability of the interventions and potential barriers to implementation through focus group discussions and in-depth interviews with the target population and relevant stakeholders. Furthermore, a cost analysis will be conducted to assess the cost-effectiveness of each intervention package.ResultsThe study protocol was approved by the Ethics Review Committee of Aga Khan University in Pakistan on January 4, 2017. Data collection began in May 2017 and was completed in July 2019. Data analyses are yet to be completed. This study will explore the effectiveness of intervention packages comprised of cash transfers from Benazir Income Support Programme with or without additional LNS and SBCC in preventing childhood stunting. We expect the results to be published in peer-reviewed journals by autumn of 2020.ConclusionsThe findings of this trial will provide robust evidence as to which intervention packages can have significant effects on linear growth of children and design effective intervention packages to prevent stunting in children aged 6 to 23 months.Trial RegistrationClinicalTrials.gov NCT03299218; https://clinicaltrials.gov/ct2/show/NCT03299218International Registered Report Identifier (IRRID)DERR1-10.2196/19001
Highlights
Child stunting remains a major barrier to human capital development worldwide
Cash transfers may be in the form of unconditional cash transfers (UCTs) or conditional cash transfers, which are provided on the condition that recipient households must carry out certain actions [7]
This study will explore the effectiveness of intervention packages comprised of cash transfers from Benazir Income Support Programme (BISP) with or without additional SNF, social and behavior change communication (SBCC), or both in preventing childhood stunting
Summary
Child stunting remains a major barrier to human capital development worldwide. In Pakistan, the prevalence of stunting in children younger than 5 years has remained above global critical levels over the last two decades, with the stunting rate being 40.2% in 2018. Social protection is increasingly recognized globally as a strategic tool to improve maternal and child nutrition outcomes due to its ability to alleviate poverty and social vulnerability. In Pakistan, the prevalence of stunting in children younger than 5 years has remained above global critical levels over the past two decades, with the stunting rate being 40.2% in 2018. As a continuing public health concern, it is essential that stunting prevention is a national priority in order to ensure human capital development, especially among the poorest households
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