TY - JOUR
T1 - Evaluation of a package of behaviour change interventions (baduta program) to improve maternal and child nutrition in east Java, Indonesia
T2 - Protocol for an impact study
AU - Dibley, Michael John
AU - Alam, Ashraful
AU - Fahmida, Umi
AU - Ariawan, Iwan
AU - Titaley, Christiana Rialine
AU - Htet, Min Kyaw
AU - Damayanti, Rita
AU - Li, Mu
AU - Sutrisna, Aang
AU - Ferguson, Elaine
N1 - Funding Information:
In 2014, the Ministry of Health requested the Global Alliance for Improved Nutrition (GAIN) to support the Malang and Sidoarjo districts in East Java to reduce child stunting. Subsequently, GAIN initiated the Baduta (means children aged <2 years in Indonesian) program with funding from the Ministry of Foreign Affairs of the Netherlands and in collaboration with Save the Children, Paramitra Foundation, and PT Holland for water (Nazava). The experience and recommendations generated through the Baduta program will inform on efforts to improve nutrition and prevent stunting nationally in Indonesia. GAIN invited the University of Sydney, in collaboration with the Centre for Health Research, Universitas Indonesia, and the London School Hygiene and Tropical Medicine to conduct a comprehensive theory-driven evaluation designed to learn about the factors affecting program delivery and the achievement of the impact of the interventions [23,24]. This paper describes the study protocol for the impact and process evaluations of the Baduta program.
Funding Information:
The authors extend thanks to the following organizations that contributed to the development of the Baduta program: Directorate of Community Nutrition, Ministry of Health, Indonesia; East Java Provincial Health Office; District Health Offices of Sidoarjo and Malang; Yayasan Sayangi Tunas Cilik; Save the Children; Paramitra Foundation; and PT Holland for Water (Nazava). In addition, the authors would like to thank the staff at GAIN, both past and present, for their support with the design of phase 1 of the Baduta program evaluation, including Lynnette Neufeld and Alison Tumilowicz. This paper is based on the evaluation of phase 1 (2014-2017) of the GAIN Baduta program in the Sidoarjo and Malang districts of East Java. The study was funded by a grant from the Kingdom of the Netherlands to GAIN (activity number: 400000062), who contracted a consortium led by the University of Sydney to conduct an independent impact evaluation. Responsibility for the contents and for the opinions expressed rests solely with the authors; publication does not constitute an endorsement by the Netherlands Ministries of Foreign Affairs.
Publisher Copyright:
© Michael John Dibley, Ashraful Alam, Umi Fahmida, Iwan Ariawan, Christiana Rialine Titaley, Min Kyaw Htet, Rita Damayanti, Mu Li, Aang Sutrisna, Elaine Ferguson. Originally published in JMIR Research Protocols (http://www.researchprotocols.org),08.09.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.
PY - 2020/9
Y1 - 2020/9
N2 - Background: Over the past decade, the prevalence of stunting has been close to 37% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. Objective: This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. Methods: The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. Results: In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. Conclusions: The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia.
AB - Background: Over the past decade, the prevalence of stunting has been close to 37% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. Objective: This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. Methods: The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. Results: In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. Conclusions: The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia.
KW - Diet
KW - Feeding behavior
KW - Food
KW - Growth disorders
KW - Infant
KW - Nutrition
KW - Nutrition during pregnancy
KW - Undernutrition
KW - Water treatment
UR - http://www.scopus.com/inward/record.url?scp=85091863862&partnerID=8YFLogxK
U2 - 10.2196/18521
DO - 10.2196/18521
M3 - Article
AN - SCOPUS:85091863862
VL - 9
JO - JMIR Research Protocols
JF - JMIR Research Protocols
SN - 1929-0748
IS - 9
M1 - e18521
ER -