This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. The evaluation will collect baseline, midline, and end-line data from intervention communities, schools, and health facilities. Only baseline and endline will be collected on the comparison communities. The evaluation objectives are to test if the intervention improved indicators for (i) child anthropometry, (ii) maternal and child dietary practices, (iii) women's empowerment, and (iv) equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators.
This is an independent evaluation of World VIsion's 7-year quasi-experimental intervention ("Realizing Gender Equality, Attitudinal Change and Transformative Systems in Nutrition", REACTS-IN) to improve nutrition, nutrition-related rights and gender equality for women, adolescent girls, and children under five years of age in rural Bangladesh, Kenya, and Tanzania. REACTS-IN is a multi-sectoral approach, integrating nutrition-related determinants, such as water, sanitation, and hygiene (WASH) interventions and health systems strengthening, to improve access to quality and gender-responsive health systems with increased capacity to prevent and treat malnutrition, especially at the primary health care level. REACTS-IN includes both nutrition-specific (e.g., school-based iron-folic acid supplement program) and nutrition-sensitive (e.g., WASH education) activities delivered through local health systems and/or schools, and communities. This independent evaluation will include three data collection at baseline, midpoint, and end-line to evaluate the performance indicators for the ultimate and intermediate outcomes. This includes indicators for child anthropometry, maternal and child dietary practices, women's empowerment, and equitable health service access for nutrition and sexual and reproductive needs. The evaluation analysis will take into account gender differences in the indicators. The data collection will be carried out with intervention communities as well as with comparison communities. The estimated household sample is 463 households (women, husbands, child)/arm/country per time point, selected through a multi-stage cluster sampling methodology. The household baseline survey with a representative sample of mothers with children (0-5.9 mo; 6-23.9 mo; 24-59.9 mo) will be compared to the values at midpoint (to assess initial impact and the need for program adjustments) and at end-line (to assess the total impact of the project). The surveys will include sociodemographic, economic, and environmental information to assess the indicators for the local context. The evaluation also includes a sample of 500 school-going adolescents (250 boys, 250 girls)/arm/country per time point to assess indicators of knowledge about nutrition, menstrual hygiene management, and sexual and reproductive health. Finally, a sample of approximately 24 health staff and community leaders will provide qualitative data on gender-equitable access to services per arm/country for baseline and end-line. Although the project also is working in Somalia, this independent evaluation does not include data collection in Somalia.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
13,500
Educational training on nutrition, gender equity, WASH, sexual and reproductive health rights will take place in communities (including schools) for women, men, and adolescents
The program will help support and promote the school-based programs of weekly iron and folic acid supplementation for adolescent girls, in countries where it is allowed.
Training and support activities to make gender-equitable nutrition, health, and sexual and reproductive services in the health facilities
The program promotes and distributes bio-fortified crops, including orange-fleshed sweet potatoes, rice, beans, and corn
Brac University
Dhaka, Bangladesh
RECRUITINGConnar Consultants
Nairobi, Kenya
RECRUITINGIfakara Health Institute
Ifakara, Tanzania
NOT_YET_RECRUITINGGender equality
Percent of households with children \< 59.9 mo that have achieved gender equality
Time frame: Change between baseline and study completion, an average of 5 years
Child anthropometry
Percent of children 6-59 mo of age who are stunted
Time frame: Change between baseline and study completion, an average of 5 years
Antenatal care
Percent of mothers of children 0-6 months who attended at least four ante-natal visits during the last pregnancy from skilled health personnel
Time frame: Change between baseline and study completion, an average of 5 years
Contraception use by women and partners
Percent of women aged 15-49 years married or in union, who are currently using, or whose sexual partner is using at least one modern contraception method
Time frame: Change between baseline and study completion, an average of 5 years
Child diet
Percent of children 6-23.9 months of age, who receive minimum dietary diversity and minimum meal frequency
Time frame: Change between baseline and study completion, an average of 5 years
Sexual and reproductive health services for adolescents
Percent of adolescent girls (10-19) who report that they were offered sexual and reproductive health services
Time frame: Change between baseline and study completion, an average of 5 years
Gender equitable health services for nutrition, health, and sexual and reproductive health
Percent of health facilities promoting gender equitable and responsive nutrition, health, and sexual and reproductive services
Time frame: Change between baseline and study completion, an average of 5 years
Exclusive breastfeeding
Percent of children 0-5.9 mo who are exclusively breastfed
Time frame: Change between baseline and study completion, an average of 5 years
Use of family planning
Percent of women 15-49 y who decided to use family planning
Time frame: Change between baseline and study completion, an average of 5 years
adolescent knowledge of nutrition, menstrual hygiene, and sexual and reproductive health
Percent of adolescent girls and boys with appropriate knowledge about nutrition, menstrual hygiene, and sexual and reproductive health
Time frame: Change between baseline and study completion, an average of 5 years
maternal knowledge on nutrition
Percent of women 15-49 y with appropriate knowledge on good maternal nutrition
Time frame: Change between baseline and study completion, an average of 5 years
Attended birth deliveries
Percent of deliveries attended by skilled birth personnel
Time frame: Change between baseline and study completion, an average of 5 years
maternal knowledge of family planning
Percent of mothers who know at least 3 modern methods of family planning
Time frame: Change between baseline and study completion, an average of 5 years
maternal knowledge of exclusive breastfeeding
Percent of mothers who know at least 3 benefits of exclusive breastfeeding
Time frame: Change between baseline and study completion, an average of 5 years
mothers planting biofortified crops
Percent of mothers who have planted biofortified crops from REACTS-IN materials
Time frame: Change between baseline and study completion, an average of 5 years
mothers planting nutrient dense local vegetables
Percent of mothers who have planted nutrient dense local vegetables from REACTS-IN seeds
Time frame: Change between baseline and study completion, an average of 5 years
mothers planting trees
Percent of mothers who have planted fruit tress from REACTS-IN materials
Time frame: Change between baseline and study completion, an average of 5 years
hygenic toilets
Percent of households with hygienic toilets
Time frame: Change between baseline and study completion, an average of 5 years
community health worker visit
Percent of households that received at least one community health worker visit in last month
Time frame: Change between baseline and study completion, an average of 5 years
Adolescent iron folic acid supplements
Percent of adolescent girls who received the recommended scheme of weekly iron-folic actic supplements
Time frame: Change between baseline and study completion, an average of 5 years
health facility
Percent of health facilities scoring \> 80 on planning assessment
Time frame: Change between baseline and study completion, an average of 5 years
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