Article Text

Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania
  1. Christopher R Sudfeld1,2,
  2. Lilia Bliznashka1,
  3. Geofrey Ashery3,
  4. Aisha K Yousafzai1,
  5. Honorati Masanja3
  1. 1Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3Ifakara Health Institute, Dar es Salaam, Tanzania
  1. Correspondence to Dr. Christopher R Sudfeld; csudfeld{at}hsph.harvard.edu

Abstract

Introduction Evidence on the effects of community health worker (CHW) interventions and conditional cash transfers (CCTs) on child growth and development in sub-Saharan Africa remains sparse.

Methods We conducted a single-blind, cluster-randomised controlled trial of an integrated home-visiting health, nutrition and responsive stimulation intervention alone and in combination with CCTs to promote antenatal and child clinic attendance from 2017 to 2019 in rural Morogoro Region, Tanzania. Pregnant women and caregivers with a child <1 year of age were enrolled. Twelve villages were randomised to either (1) CHW (n=200 participants), (2) CHW+CCT (n=200) or (3) control (n=193). An intention-to-treat analysis was conducted for the primary trial outcomes of child cognitive, language and motor development assessed with the Bayley Scales of Infant and Toddler Development and child length/height-for-age z-scores (HAZ) at 18 months of follow-up.

Results The CHW and CHW+CCT interventions had beneficial effects on child cognitive development as compared with control (standardised mean difference (SMD): 0.15, 95% CI 0.05 to 0.24, and SMD: 0.18, 95% CI 0.07 to 0.28, respectively). The CHW+CCT intervention also had positive effects on language (SMD: 0.08, 95% CI 0.01 to 0.15) and motor (SMD: 0.16, 95% CI 0.03 to 0.28) development. Both CHW and CHW+CCT interventions had no effect on HAZ in the primary analysis; however, there were statistically significant positive effects in multivariable analyses. The CHW+CCT group (mean difference: 3.0 visits, 95% CI 2.1 to 4.0) and the CHW group (mean difference: 1.5 visits, 95% CI 0.6 to 2.5) attended greater number of child health and growth monitoring clinic visits as compared to the control group.

Conclusion Integrated CHW home-visiting interventions can improve child cognitive development and may have positive effects on linear growth. Combining CHW with CCT may provide additional benefits on clinic visit attendance and selected child development outcomes.

Trial registration number ISRCTN10323949.

  • child health
  • nutrition
  • cluster randomised trial
  • public health

Data availability statement

Data may be available upon request. Deidentified individual participant data (including data dictionaries) may be made available, in addition to study protocols, the statistical analysis plan and the informed consent form. Data may be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal and obtain ethical approval. Proposals should be submitted to csudfeld@hsph.harvard.edu.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

Data may be available upon request. Deidentified individual participant data (including data dictionaries) may be made available, in addition to study protocols, the statistical analysis plan and the informed consent form. Data may be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal and obtain ethical approval. Proposals should be submitted to csudfeld@hsph.harvard.edu.

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Footnotes

  • Handling editor Sanni Yaya

  • Contributors CS and HM conceptualised the study. CS, LB, GA, AY and HM developed the intervention and trial protocol. GA coordinated and supervised the data collection. LB and CS conducted the statistical analysis. CS wrote the first draft of the paper. All authors reviewed and contributed to the draft paper. All authors approved the final submission.

  • Funding This work was supported by Grand Challenges Canada grant number #R-SB-POC-1707-09024. The funder had no involvement in the study design, data collection, analysis or interpretation of the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.