Sustainable Undernutrition Reduction in Ethiopia (SURE)
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ClinicalTrials.gov Identifier: NCT04694898 |
Recruitment Status :
Completed
First Posted : January 5, 2021
Last Update Posted : May 3, 2021
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The causes of malnutrition are complex and addressing the problem requires integrated action among various sectors. Globally, much attention has been given to nutrition-specific interventions to address the immediate causes of undernutrition. But undernutrition prevalence is decreasing at a very slow rate. Nutrition-specific interventions address the immediate determinants of child undernutrition, such as inadequate food and nutrient intake, but do not consider the underlying causes such as food insecurity, poverty, and limited access to clean water, hygienic environments, and health services.
Ethiopia still has a high prevalence of undernutrition. The current situation of food insecurity and malnutrition in Ethiopia has pressurized the government in pursuing a number of nutritional-sensitive interventions to increase diversified food production and consumption like the Sustainable Undernutrition Reduction Program (SURE).
This study aims to investigate whether joint nutrition specific and sensitive interventions can lead to improved household food security, dietary diversification and improved nutritional status in Ethiopian mothers and their young children.
The study will be a community based longitudinal design and will use multistage cluster sampling at the Kebele and household levels in Amhara, Oromia, and Southern Nations, Nationalities, and Peoples' Region (SNNPR) regions.
Households will be randomly selected from the intervention and the non-intervention arms at Kebele level, with 15 households per Kebele. The same children whose baseline are available who were 0-23 months of age at the time of the baseline assessment in 2016 will be recruited as well as their mothers. This represents approximately third of the total sample size at baseline.
Condition or disease | Intervention/treatment | Phase |
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Stunting Dietary Deficiency Anemia | Behavioral: Standard programme Behavioral: SURE intervention | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 1292 participants |
Allocation: | Non-Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | The study is part of the evaluation of the Government project "SURE". SURE intervention districts were pre-selected in four regions out of the nine regions in Ethiopia. The regions were selected because they are agrarian and have high food insecurity and stunting prevalence (Oromia, Amhara, SNNPR and Tigray). A total of 36 districts were selected and assigned to the SURE intervention. Comparison control districts were selected in equal number in the same four agrarian regional strata. Districts were roughly matched based on stunting prevalence tertiles (low, medium or high) and food insecurity scores. Eligible households are households with at least one child under the age of 2 years. The intervention started in 2016 and included 4299 households, 2146 of which were included in the intervention group and 2153 in the control group. After baseline data collection, all households in the intervention group received counselling at household and community levels. |
Masking: | None (Open Label) |
Primary Purpose: | Prevention |
Official Title: | Integrating Health and Agriculture Services for Improved Household Food Security and Nutritional Status of Mothers and Children 4-6 Years of Age |
Actual Study Start Date : | December 28, 2020 |
Actual Primary Completion Date : | March 13, 2021 |
Actual Study Completion Date : | March 13, 2021 |
Arm | Intervention/treatment |
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Control
Households in the control arm receive standard/national nutrition specific interventions, i.e. growth monitoring, vaccination, vitamin A supplementation and deworming
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Behavioral: Standard programme
The control arm will receive national standard programme for women and children under the age of 2 years. This includes 1) national nutrition and health care including iron & folic acid (IFA) supplementation in pregnancy; 2) early initiation and exclusive breastfeeding until 6 months of age; 3) timely introduction of liquid and semi-solid complementary foods; and 4) diversified complementary foods.
Other Name: Control |
Experimental: SURE Intervention
Households in the intervention group with children younger than 2 years benefit from:
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Behavioral: SURE intervention
The SURE package includes: 1) promoting diversified agriculture; 2) promoting infant and young child feeding practices; 3) women empowerment in decision making related to agriculture, food and health; and 4) enhanced food security and Water, Sanitation and Hygiene ("WASH") practices.
Other Name: Intervention |
- Hemoglobin (g/dl) [ Time Frame: Changes in hemoglobin (g/dl) and in prevalence of anemia (<11g/dl) will be measured over the course of the four year program period. ]Hemoglobin concentrations (g/dL)
- Linear growth (Z-score and prevalence) [ Time Frame: Change in height-for-age Z-scores will be measured as well as the change in the prevalence of stunting (HAZ<-2) over the course of the four year program period. ]Child height (cm) and its Z-score
- Dietary diversity (%) [ Time Frame: Baseline (2016) and after 4 years at endline (2020) ]Measured with a questionnaire using a qualitative food frequency questionnaire. Unit: Number of food group consumed and percentage of children having consumed 4 groups (upon 7) the previous three days.
- Food insecurity access prevalence (%) [ Time Frame: Baseline (2016) and after 4 years at endline (2020) ]Measured with a questionnaire to calculate the Household Food Insecurity Access score.
- Women's empowerment in agriculture (%) [ Time Frame: After 4 years of intervention (endline, 2020) ]Measured by questionnaire, It measures the roles and extent of women's engagement in the agriculture sector in five domains: (1) decisions about agricultural production, (2) access to and decision making power over productive resources, (3) control over use of income, (4) leadership in the community, and (5) time use. Percentage of women over a calculated score.
- Maternal knowledge of child care practices related to health/diet/WASH (%) [ Time Frame: Baseline (2016) and after 4 years at endline (2020) ]Using questionnaire on knowledge. Percentage of women giving adequate answer.
- Maternal practices of child care related to health/diet/WASH (%) [ Time Frame: Baseline (2016) and after 4 years at endline (2020) ]Using questionnaire on practices. Percentage of women giving adequate answer.
- Child weight (Z-score and %) [ Time Frame: Measurements were made for children between the ages of 0 and 23 months of age at baseline and 4 years later, at endline, when the children are between the ages of 4 and 6 years. ]Child weight (kg) and its Z-score
- Agricultural production diversity [ Time Frame: Baseline (2016) and after 4 years at endline (2020) ]The production of different food groups by the household members that correspond to those groups used in the dietary diversity index.
- Wasting (Z-score and %) [ Time Frame: Baseline in children 0-23 months of age and endline in children 4-6 years of age ]Child weight for height Z-score
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Ages Eligible for Study: | 4 Years to 6 Years (Child) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Children 4 years - 6 years and their mothers/fathers and caregivers
- Participated in the baseline survey (2016)
- Resided in the Control communities during the last four years (control arm), or in the SURE intervention communities (intervention arm).
Exclusion Criteria:
-
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): NCT04694898
Ethiopia | |
Ethiopia Public Health Institute | |
Addis Ababa, Ethiopia |
Principal Investigator: | Stefaan De Henauw, Md. PhD | University of Ghent | |
Principal Investigator: | Souheila Abbeddou, MSc. PhD | University of Ghent |
Publications of Results:
Responsible Party: | University Ghent |
ClinicalTrials.gov Identifier: | NCT04694898 |
Other Study ID Numbers: |
BC-08862 |
First Posted: | January 5, 2021 Key Record Dates |
Last Update Posted: | May 3, 2021 |
Last Verified: | December 2020 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Plan Description: | All the data collected in the evaluation survey will be used in the analyses and shared as necessary. |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Stunting Diet diversity Food production Household food security |
Women empowerment Knowledge, Attitudes and Practices Anemia Malaria |
Malnutrition Growth Disorders Pathologic Processes Nutrition Disorders |