RINEW

Research on Integration of Nutrition Early Childhood Development WASH (RINEW)

Objectives

1. Assess the feasibility (i.e. satisfaction of providers, perceived appropriateness of content and practicability of session delivery, population demand for sessions, quality and frequency of implementation, and preparedness of health system) of implementing the RINEW intervention through the government health system

2. Identify barriers, facilitators/opportunities, and pathway for scale up of the RINEW intervention through government health system

3. Assess the coverage of the intervention in the target population

4. Assess the uptake of recommended behaviors in the target population

Rationale

More than 200 million children under age 5 years are failing to reach their full potential of cognitive development. Implementing an integrated intervention through government health system to address multiple barriers to optimal child development will provide evidence for policy development to implement an integrated intervention at-scale. Conventional vertical programs deliver one type of intervention to address maternal, and child nutrition, water, sanitation, hygiene, psychosocial stimulation or reducing environmental lead and arsenic exposure. Integrated intervention can be effective in improving child’s cognitive development. However, the practical experience of implementing an integrated intervention through existing government health system in low income country settings is quite limited.

The RINEW intervention is a group-based integrated nutrition, responsive stimulation, and WASH intervention with a goal to improve child development outcomes. The intervention is delivered in group sessions to pregnant women and mothers or primary caregivers of children under 24 months of age. The RINEW intervention was tested in a pilot cluster-randomized control study in Bangladesh, where we found the intervention group had better self-reported knowledge and behavior related to early child development. We aim to implement this intervention through the government health system in one subdistrict of Bangladesh and assess the feasibility of delivering the intervention in this way, as well as the uptake of the intervention in the target population. The facilitators will be trained by our study team, and the intervention will be implemented in community-level health centers, facilitated by government health workers.

Project Dates

September 2016 – June 2020

Stage of Work

Results from the RINEW pilot trial showed that the mothers randomized to the RINEW integrated intervention obtained higher scores on the family care indicator (FCI) after 9 months of intervention, indicating their children had more opportunities for simulation within the home. The intervention group also had higher indicators of maternal and child dietary diversity, and lower maternal depressive symptoms as compared to the control group.

The endline assessment of RINEW will be conducted in spring 2020.

People

Primary Contact: Laura Kwong

Overall Project

Stanford: Stephen Luby

ICDDR,B: Mahbub Rahman, Tania Jahir, Jesmin Sultana

Johns Hopkins University: Peter Winch

Child Stimulation

ICDDR,B: Fahmida Tofail

UC Berkeley: Lia Fernald, Helen Pitchik

Nutrition

ICDDR,B: Malay Mridha