Rural Jharkhand Research Articles

Double Burden of Malnutrition Among Pregnant Women in Rural Jharkhand: Evidence From a Cross-Sectional Study

Double Burden of Malnutrition Among Pregnant Women in Rural Jharkhand: Evidence From a Cross-Sectional Study

Social and spatial factors of livelihood diversification of marginal and small landholding households in rural Jharkhand, India

Social and spatial factors of livelihood diversification of marginal and small landholding households in rural Jharkhand, India

Responsiveness of Public and Private Education Providers During COVID-19: Parental Perspective from Jharkhand, India

ABSTRACT The COVID-19 pandemic disrupted the K-12 education system. We surveyed 4,162 parents across five districts in rural Jharkhand to examine which K-12 service provider parents perceived to be responsive during COVID-19. We rely on parental perception, satisfaction, and aspirations to evaluate and compare the COVID-19 responsiveness of public and private education providers in rural Jharkhand’s low-income neighborhoods. We also test children on a functional literacy and numeracy tool to corroborate parental perception. We find that a higher proportion of parents perceived that private education providers were responsive during the COVID-19-induced lockdown compared to public schools. We also observe that parental perception is aligned with the learning scores of children.

Teletherapy as an Alternate Model for Therapeutic Interventions for Children with Neurodevelopmental Disabilities in a Low-resource Setting in Jharkhand, India

Abstract Background: This project was a collaboration between a community-based organization in rural India and a professional organization providing training and teletherapy support. The objective was to address the human resource gaps in rural areas for delivering therapeutic interventions to children with neurodevelopmental disabilities (NDD) in low-resource settings. Objective: To empower health workers in rural areas with the skills necessary to provide need-based therapeutic interventi ons to children with developmental disabilities through training and teletherapy. Methods: The project began with an initial training phase consisting of 10 online training sessions. This was followed by five additional need-based online training sessions over a 9-month period. Thirty-one children with NDD (15 girls and 16 boys) were enrolled and tracked using the Canadian Occupational Performance Measure (COPM). A total of 750 need-based therapy interventions, including physiotherapy, occupational therapy, and speech therapy, were provided by professional therapists via teletherapy. Results: The children showed significant improvement in the functional goals set from baseline to midline and end line. A one-way repeated-measures ANOVA test revealed a significant positive impact of teletherapy on the functional goals planned for the sample (P < 0.5). Conclusion: Teletherapy demonstrated a positive impact on achieving functional goals for children with NDD in rural Jharkhand. It is recommended as an effective model to address human resource gaps and provide family-centered therapeutic support in low-resource rural areas.

The process, outcomes and context of the sanitation change induced by the Swachh Bharat Mission in rural Jharkhand, India

BackgroundThe Indian Swachh Bharat Mission (SBM) was launched in 2014 with the goal to make India open defecation (OD) free by October 2019. Although it is known that the ambitious goal was not achieved, the nature of the sanitation change brought about by the SBM in different parts of India is poorly understood. One reason is a dearth of case studies that would shed light on the performance of the SBM simultaneously across its different domains. This article provides an example of such study. Employing a Process, Outcomes, Context approach, the objective is to understand the process and outcomes of the SBM-induced sanitation change in a specific context of rural Jharkhand.MethodsThe study utilizes data collected through field research conducted in the rural areas of Ranchi district, Jharkhand, a state in east-central India. This data was obtained via repeated cross-sectional household surveys conducted at the beginning and at the end of the SBM, supplemented by key informant interviews with SBM stakeholders.FindingsWe identified political support of SBM implementation and its acceptance amongst the population. Female community workers became key agents of SBM implementation at local level. The SBM increased toilet coverage in the study area from 15% to 85% and lowered the OD rate from 93% to 26%. It substantially reduced structural inequalities in access to toilets, furthered social sanitation norms, improved some of the attitudes towards toilet use, but impacted less on hygiene and sanitation knowledge. The implementation mainly concentrated on the construction of subsidized toilets but less on improving public understanding of safe sanitation practices.ConclusionsAlthough the SBM reduced sanitation inequalities in access to toilets in the study area, the behaviour change component was underplayed, focusing more on spreading normative sanitation messages and less on public education. Sustainability of the observed sanitation change remains a key question for the future. This article calls for more systematic production of geographically situated knowledge on the performance of sanitation interventions.

Faces of tuberculosis: a riveting exploration into demographics and health profiles of patients in rural Jharkhand

Background: Tuberculosis is a pressing health concern in Jharkhand, India, claiming 13,000 lives annually. This retrospective study, conducted by Tata steel foundation, delves into the health and sociodemographic profiles of TB patients in the tribal-dominated East Singhbhum district. Noteworthy findings include risk factors such as Anaemia, Diabetes compounded by challenges like limited access to health facilities. TSF's initiatives, including Nikshay Mitra and support for NTEP, are crucial components in addressing TB in the region. Methods: A retrospective study (September to November 2023) analyzed records from TSF's DOTS centre in East Singhbhum. Data from 2019-2023 were extracted and analyzed using descriptive statistics. Results: The average age of 293 patients was 37.36±14.97 years, with 83.6% belonging to Scheduled Tribes. Sputum analysis revealed a 61.4% positive rate for Acid Fast Bacillus. Notably, 85.3% completed treatment, and abnormal chest radiographs were observed in 99.3% of cases. Conclusions: The proposed way forward outlines actionable strategies to further strengthen TB awareness, focus on challenging districts, engage communities, and collaborate with government health centers. Regular research and monitoring, coupled with periodic impact assessments, will be crucial for adapting and refining interventions in alignment with the dynamic landscape of TB prevalence.

Roots of change: intergenerational cycle of adolescent fatherhood in rural Jharkhand and Odisha

Background: Numerous studies have documented an intergenerational cycle of adolescent motherhood, wherein daughters of adolescent mothers are more likely to follow suit. This pattern may result from biological predisposition, heritable attitudes, or the socioeconomic environment influenced by early childbirth. Surprisingly, the same cycle among young fathers remains unexplored in India. This research paper seeks to enrich the existing body of knowledge by shedding light on the intergenerational cycle of adolescent fatherhood in the rural Jharkhand and Odisha, possibly as a first of its kind study. Methods: A case control study was conducted between June 2023 to August 2023 amongst adolescent males residing in rural areas of Jharkhand and Odisha states with sample size of 228 using multi-stage sampling technique. Results: The study did not reveal statistically significant association between adolescent fathers of this generation and adolescent fathers or adolescent mothers of previous generation, unlike in the case of adolescent mothers. Conclusions: To address adolescent reproductive sexual Health challenges in rural Jharkhand and Odisha effectively, it is imperative to emphasize targeted educational campaigns with cultural sensitivity, actively involve adolescent males and maintain a steadfast long-term commitment to fostering cultural transformation.

Mapping the Pluralities of Agrarian Change in India: The Role of Intermediaries and Caste–Tribe Relations in Jharkhand

The agricultural economy of Jharkhand is primarily understood to be ‘subsistence’ agriculture. However, an ongoing agrarian change in rural Jharkhand has drawn less academic attention. This substantial change is from indigenous seeds to high-yielding varieties of paddy seeds enabling food sufficiency in the villages to a larger extent. In addition, the introduction of commercial crops like vegetables, watermelons and marigolds is another attendant change. This article is concerned with ethnographic fieldwork in two neighbouring villages of district—Khunti of Jharkhand, where farmers have been influenced by intermediaries (both old and new) restricted to State, NGOs and private companies (agricultural input suppliers). Also, the introduction of various governmental schemes, such as the ‘Bringing Green Revolution to Eastern India (BGREI)’ programme, a part of ‘National Food Security Mission’ and ‘Special-Swarna Jayanti Gram Swarozgar Yojana’, has encouraged agrarian change in rural Jharkhand. Despite Jharkhand being a low agricultural productivity region, there is a proliferated presence of transnational connections such as agribusiness companies and research institutions linked to State institutions and NGOs to form a new set of agricultural intermediaries. These agricultural intermediaries at the regional level in the Khunti district influence the crop choice, cropping pattern and usage of inputs (seeds, fertilisers and pesticides). The study also tries to understand agrarian (labour) relations among caste–tribe communities of rural Jharkhand.

Greater Social Mobility of Tribal Women in Rural Jharkhand: A Case Study Business Women and Women Entrepreneurs, A Pilot Study from Jharkhand

Abstract: Entrepreneurship is the ability and readiness to develop, organize and run a business enterprise, along with any of its uncertainties to make a profit. Despite men and women gliding through the same entrepreneurial process, women face distinct dimensions and intense challenges in realizing their potential. When women or groups of women embark on initiating, organizing, and managing their enterprise, they are termed as women entrepreneurs. There is indeed a difference between an entrepreneur and a businesswoman. After all, both are about running a business and leading teams. It is also true that an entrepreneur can become a businesswoman. businesswomen walk on a defined path, but an entrepreneur believes in making his own path, which becomes a guideline for other businesswomen.

Making Nutritious Diets More Affordable: Findings from a Cost of Diet Assessment in West Singhbhum, Jharkhand, India

Background: India bears a disproportionate burden of undernutrition. Access to an affordable, nutritious diet is one of the critical challenges. There is a need to assess the cost of a nutritious diet and find ways to understand and minimise the affordability gap through a comprehensive approach.
 Objective: The present study was conducted in the West Singhbhum district of Jharkhand, India. Its objective was to find out the cost of various diets, and their affordability, based on households’ accounting for their total food expenditure, and assessing the coverage of essential governments’ nutrition-specific interventions to use a model for suggesting ways to minimise the affordability gap. We also estimate the potential impact of nutrition-sensitive programmes on household food affordability.
 Methodology: The study employed the Cost of the Diet (CotD) methodology, a mixed-method, cross-sectional assessment, where the research team conducted surveys in 16 markets, 12 focus group discussions (FGDs) and 96 individual interviews (IDIs). Additionally, 434 household-level surveys were conducted to understand income, expenditure patterns in the localities and uptake of key nutrition-sensitive interventions. Secondary information from the 68th round of the National Sample Survey 2012 were used to assess rural Jharkhand’s non-food expenditure (NFE). Data were analysed primarily using the Save the Children’s Cost of the Diet software version 2.5.2.
 Results: The cost of the diet increased with an increase in the diet quality – from a basic energy-only diet costing INR 33,892 ($505.85)[1] per year for a standard household with 6 members to a food-habit nutritious diet (FHAB) costing INR 70,627 ($1054.13) per year. More than half of the sampled households could not afford a nutritious diet. The poorest quartile was spending 56.8% of income on food, compared to 33.7% for the richest quintile.
 Conclusion: The cost of a FHAB diet should be used as a benchmark to track the progress of beneficiary groups in upcoming socio-economic assessments. Changes in the affordability gap should be observed to assess whether new initiatives have worked. Optimal coverage of existing nutrition-specific and nutrition-sensitive programmes has the potential to reduce the cost of a FHAB nutritious diet by up to 30%.
 [1] $1=INR 67 (The exchange rate at the time of data collection, December 2019)

Accessing Antenatal Care (ANC) services during the COVID-19 first wave: insights into decision-making in rural India

BackgroundAntenatal care (ANC) services are a prime focus of the Government of India's National Health Mission (NHM), of which a key pillar is the promotion of maternal and child health. To ensure uninterrupted service delivery at the last mile, a cadre of Frontline Health Workers (FLHWs) has been appointed and health centres established at the village level. However, the onset of the COVID-19 pandemic and the nationwide lockdown from late March to June 2020 impacted pregnant women's access to institutional antenatal care services. MethodsUsing a qualitative research design, data was collected through 12 in-depth interviews (IDIs) with pregnant women and 17 IDIs with frontline health workers in the selected six districts under study. The narratives were analysed using inductive coding in Atlas.ti.ResultsDuring the first wave of the COVID-19 pandemic, pregnant women, most of whom belonged to poor and marginalised groups, were left with limited access to health centres and FLHWs. Respondents from the study areas of rural Jharkhand, Madhya Pradesh and Uttar Pradesh extensively reported concerns stemming from the lockdown that influenced their decision to access ANC services. These included anxieties around meeting their families' daily needs due to a loss of livelihood (in particular, abject food insecurity), inability to access healthcare, and a sense of mistrust in public health systems and functionaries. All of these, coupled with the real threat to health posed by COVID-19, disrupted their plans for pregnancy and delivery, further compunding the risk to their health and wellbeing.ConclusionThis study identified several social, behavioural and structural facets of the communities that contributed to the confusion, anxiety and helplessness experienced during the COVID-19 first wave by both groups, viz. pregnant women and FLHWs. In planning and implementing initiaves to ensure the delivery and uptake of ANC services in this and similar contexts during times of crisis, these facets must be considered.

Female Workforce Participation and Vulnerability in Employment: Evidence from Rural Jharkhand

Female Workforce Participation and Vulnerability in Employment: Evidence from Rural Jharkhand

The digital divide, gender and education: challenges for tribal youth in rural Jharkhand during Covid-19

When analysing the Covid-19 pandemic potential consequences on education, it is evident that it had adverse effects on the existing educational inequalities worldwide. However, little is known about how the digital divide have worsened the conventional educational system and reinforced pre-existing gender inequalities among the historically marginalised communities. This research paper explores how the pandemic, along with digital divide, deteriorated the educational system among the socially deprived groups (i.e. tribals also known as indigenous or Adivasis) and place them in a disadvantageous position. The paper reflects on how the Covid-19 pandemic re-configured the pre-existing issues of educational inequalities and how the digital dived have been manifested in a way that has particularly affected the young tribal girls. For this study, semi-structured interviews with tribal students, their parents and teachers residing in a remote area of Jharkhand, India, were conducted to understand their experiences of shifting to online education mode. Other than accessibility and infrastructure issue, the findings reveal that the elements of cultural and social issues (related to perceived benefits of education for girls and mindset or beliefs parents and teachers towards effectiveness of digital mode of education delivery) create and reinforce the digital divide for the tribal girls in the hinterlands. Based on the information collected from the interview, the study emphasises on re-thinking the digital learning ecosystem and provide policy recommendations to counteract the worsening digital divide and educational inequalities among socially deprived groups.

Predictors of Positive Psychological Capital: An Attempt Among the Teacher Communities in Rural Jharkhand, India

In the recent times, researchers have shown an increased interest in positive psychological capital (PsyCap). However, it is acknowledged that due to the limited number of studies conducted on the antecedents of psychological capital, there is a lack of sufficient data for conclusively proving the antecedents of PsyCap. Consequently, this article aims to explore the potential antecedents of PsyCap as a reliable source of data in the context of rural school teachers. The focus is to investigate both the individual differences and the contextual factors as desirable variables that constitute PsyCap among the school teachers of rural Jharkhand, India. Samples of 1,120 respondents from different rural schools were collected and analysed with Structural Equation Modeling (AMOS 20.0). The findings of the study explained that both the individual differences ( proactive personality and emotional intelligence) and the contextual factors ( perceived organizational support, servant leadership and meaningful work) have a positive relationship with PsyCap. The impact of PsyCap on teacher performance can form the basis for further research on the subject. JEL Codes: M12, M53

A cross sectional study on school absenteeism among female adolescents during menstruation in the rural Jharkhand

Background: Girls especially during menstruation are likely to be affected in different ways by inadequate water, sanitation and hygiene conditions in schools, and this may contribute to unequal learning opportunities. For example, lack of adequate, separate private and secure toilets and washing facilities may discourage parents from sending girls to school. The objective of the study was to find the relation between wash facility and school absenteeism among the girls from a rural community of Jharkhand.Methods: Community based cross sectional study at the rural area among the school girls of classes 8 to 10. Pre tested semi structured questionnaire was used. Data entry at MS Excel and data analysis was done using Statistical Package for Social Sciences (SPSS) software, version 20.0.Results: The mean age at menarche was 12.13 years. At school, separate wash area for girls was present in most of the cases 228 (61.1%). About 39 (9.9%) participants did not attend school during the menstrual days. Of this 29 (74%) believed that lack of separate wash at schools was a reason.Conclusions: Presence of separate wash area for girls at school was significantly (p-value<0.001) associated with good attendance during menstruations (96%).

Community mobilisation to prevent violence against women and girls in eastern India through participatory learning and action with women\u2019s groups facilitated by accredited social health activists: a before-and-after pilot study

BackgroundAlmost one in three married Indian women have ever experienced physical, sexual, or emotional violence from husbands in their lifetime. We aimed to investigate the preliminary effects of community mobilisation through participatory learning and action groups facilitated by Accredited Social Health Activists (ASHAs), coupled with access to counselling, to prevent violence against women and girls in Jharkhand, eastern India.MethodsWe piloted a cycle of 16 participatory learning and action meetings with women’s groups facilitated by ASHAs in rural Jharkhand. Participants identified common forms of violence against women and girls, prioritised the ones they wanted to address, developed locally feasible strategies to address them, implemented the strategies, and evaluated the process. We also trained two counsellors and two ASHA supervisors to support survivors, and gave ASHAs information about legal, health, and police services. We did a before-and-after pilot study involving baseline and endline surveys with group members to estimate preliminary effects of these activities on the acceptability of violence, prevalence of past year emotional and physical violence, and help-seeking.ResultsASHAs successfully conducted monthly participatory learning and action meetings with 39 women’s groups in 22 villages of West Singhbhum district, Jharkhand, between June 2016 and September 2017. We interviewed 59% (679/1149) of women registered with groups at baseline, and 63% (861/1371) at endline. More women reported that violence was unacceptable in all seven scenarios presented to them at endline compared to baseline (adjusted Odds Ratio [aOR]: 1.87, 95%: 1.39–2.52). Fewer women reported experiencing emotional violence from their husbands in the last 12 months (aOR: 0.55, 95% CI: 0.43–0.71), and more sought help if it occurred (aOR: 2.19, 95% CI: 1.51–3.17). In addition, fewer women reported experiencing emotional or physical violence from family members other than their husbands in the last 12 months (aOR: 0.41, 95% CI: 0.32–0.53, and aOR: 0.36, 95% CI: 0.26–0.50, respectively).ConclusionCombining participatory learning and action meetings facilitated by ASHAs with access to counselling was an acceptable strategy to address violence against women and girls in rural communities of Jharkhand. The approach warrants further implementation and evaluation as part of a comprehensive response to violence.

Community youth teams facilitating participatory adolescent groups, youth leadership activities and livelihood promotion to improve school attendance, dietary diversity and mental health among adolescent girls in rural eastern India: protocol for a cluster-randomised controlled trial

BackgroundImproving the health and development of adolescents aged 10–19 years is a global health priority. One in five adolescents globally live in India. The Rashtriya Kishor Swasthya Karyakram (RKSK), India’s national adolescent health strategy, recommends supporting community-based peer educators to conduct group meetings with boys and girls. Groups aim to give adolescents a space to discuss the social and health issues affecting them and build their capacity to become active community members and leaders. There have been no evaluations of the community component of RKSK to date. In this protocol, we describe the evaluation of the Jharkhand Initiative for Adolescent Health (JIAH), a community intervention aligned with RKSK and designed to improve school attendance, dietary diversity and mental health among adolescent girls aged 10–19 years in rural Jharkhand, eastern India.MethodsThe JIAH intervention is delivered by a community youth team consisting of yuva saathis (friends of youth), youth leadership facilitators and livelihood promoters. Teams conduct (a) peer-led Participatory Learning and Action meetings with girls and boys, mobilising adolescents, parents, health workers, teachers and the wider community to make changes for adolescent health and development; (b) group-based youth leadership activities to build adolescents’ confidence and resilience; and (c) livelihood promotion with adolescents and their families to provide training and practical skills. We are evaluating the JIAH intervention through a parallel-group, two-arm, superiority, cluster-randomised controlled trial. The unit of randomisation is a geographic cluster of ~1000 people. A total of 38 clusters covering an estimated population of 40,676 have been randomised to control or intervention arms. Nineteen intervention clusters have adolescent groups, youth leadership activities and livelihood promotion. Nineteen control clusters receive livelihood promotion only. Study participants are adolescent girls aged 10–19 years, married or unmarried, in or out of school, living in the study area. Intervention activities are open to all adolescent boys and girls, regardless of their participation in surveys. We will collect data through baseline and endline surveys. Primary trial outcomes are school attendance, dietary diversity and internalising and externalising mental health problems. Secondary outcomes include access to school-related entitlements, emotional or physical violence, self-efficacy and resilience.Trial registrationISRCTN17206016. Registered on 27 June 2018.

Mortality and recovery following moderate and severe acute malnutrition in children aged 6-18 months in rural Jharkhand and Odisha, eastern India: A cohort study.

BackgroundRecent data suggest that case fatality from severe acute malnutrition (SAM) in India may be lower than the 10%–20% estimated by the World Health Organization (WHO). A contemporary quantification of mortality and recovery from acute malnutrition in Indian community settings is essential to inform policy regarding the benefits of scaling up prevention and treatment programmes.Methods and findingsWe conducted a cohort study using data collected during a recently completed cluster-randomised controlled trial in 120 geographical clusters with a total population of 121,531 in rural Jharkhand and Odisha, eastern India. Children born between October 1, 2013, and February 10, 2015, and alive at 6 months of age were followed up at 9, 12, and 18 months. We measured the children’s anthropometry and asked caregivers whether children had been referred to services for malnutrition in the past 3 months. We determined the incidence and prevalence of moderate acute malnutrition (MAM) and SAM, as well as mortality and recovery at each follow-up. We then used Cox-proportional models to estimate mortality hazard ratios (HRs) for MAM and SAM. In total, 2,869 children were eligible for follow-up at 6 months of age. We knew the vital status of 93% of children (2,669/2,869) at 18 months. There were 2,704 children-years of follow-up time. The incidence of MAM by weight-for-length z score (WLZ) and/or mid-upper arm circumference (MUAC) was 406 (1,098/2,704) per 1,000 children-years. The incidence of SAM by WLZ, MUAC, or oedema was 190 (513/2,704) per 1,000 children-years. There were 36 deaths: 12 among children with MAM and six among children with SAM. Case fatality rates were 1.1% (12/1,098) for MAM and 1.2% (6/513) for SAM. In total, 99% of all children with SAM at 6 months of age (227/230) were alive 3 months later, 40% (92/230) were still SAM, and 18% (41/230) had recovered (WLZ ≥ −2 standard deviation [SD]; MUAC ≥ 12.5; no oedema). The adjusted HRs using all anthropometric indicators were 1.43 (95% CI 0.53–3.87, p = 0.480) for MAM and 2.56 (95% CI 0.99–6.70, p = 0.052) for SAM. Both WLZ < −3 and MUAC ≥ 11.5 and < 12.5 were associated with increased mortality risk (HR: 3.33, 95% CI 1.23–8.99, p = 0.018 and HR: 3.87, 95% CI 1.63–9.18, p = 0.002, respectively). A key limitation of our analysis was missing WLZ or MUAC data at all time points for 2.5% of children, including for two of the 36 children who died.ConclusionsIn rural eastern India, the incidence of acute malnutrition among children older than 6 months was high, but case fatality following SAM was 1.2%, much lower than the 10%–20% estimated by WHO. Case fatality rates below 6% have now been recorded in three other Indian studies. Community treatment using ready-to-use therapeutic food may not avert a substantial number of SAM-related deaths in children aged over 6 months, as mortality in this group is lower than expected. Our findings strengthen the case for prioritising prevention through known health, nutrition, and multisectoral interventions in the first 1,000 days of life, while ensuring access to treatment when prevention fails.

Participatory Rural Planning for Sustainable Agriculture: An Observation from Rural Jharkhand of India

From the study it is concluded that after implementation of the scheme, 93% respondents stated that they have been provided irrigation facilities for farming to enhance agriculture productivity. Around 91.8% respondents admitted that due to the provision of irrigation facilities for farming, the production of commercial crops (89.5% respondents) have increased and 91.8% respondents stated that agriculture lands have been covered under cultivation.

Effects of participatory learning and action with women\u2019s groups, counselling through home visits and cr\xe8ches on undernutrition among children under three years in eastern India: a quasi-experimental study

BackgroundIndia faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women’s groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits.MethodsWe tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation’s primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children.ResultsWe interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51–0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59–0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96–1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55–0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47–0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57–0.93).ConclusionsCrèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches.Trial registrationThe evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019.