Studying effectiveness: Considerations in

research design and implementation

Shibani Ghosh

Feed the Future

Innovation Laboratory

for Collaborative Research on Nutrition

Community

Connector

programme

Maternal/Child

Nutrition

ENA and

EHA

Agricultural and

post harvest

Technologies

Risk management,

Micro-credit

Savings

Service

Quality

Income,

Health

Diet

Quality

??

Gender

approaches

Sectoral

coordintn

?

80,000

households

15 districts of

Uganda

Suaahara FTF program

Diet

Quality

Maternal/Child

Nutrition

ENA/EHA

Home

gardens

Agric.

Extension

Service

Quality

New

seeds

Irrigation

Diet

Quantity

(and

Quality)

Rural

finance

??

Poultry,

goats

Sectoral

coordintn

Suaahara (25 districts), Feed the Future (20 districts)

Research Design Considerations

� Randomized control trial (RCT)� Number of treatments (single and combination)

� Ability to detect differences between treatments

� Resource and management scope

� Research design around existing program design� Purposive selection of districts

� Non randomized roll out

� Co-existence of multiple programs

� Question of “how” and not “what”

Research Design

� Observational

� Randomized site selection with counterfactuals and pre-post in Nepal and Uganda

� Observational cohort annual panel survey and Longitudinal sentinel sites in Nepal

� Cohort panels and quasi experimental

longitudinal birth cohort in Uganda

Policy and Programmatic considerationsSuaahara (25 districts), Feed the Future (20 districts)

GAFSP (7 districts), Multisectoral Nutrition Plan (incremental roll-out; from 6 districts in Year 1 to 75 by Year 5), Sunaula Hazar Din “Golden First 1000 Days” (15 districts)……

4500 households

Surveillance system to assess program response to agriculture,

health & nutrition programs in Nepal: annual panel surveys and

sentinel sites

Mountain543 VDCs

Hills2,034 VDCs

Terai1,394 VDCs

List Districts from west-to-east and VDCs alphabetically within each district by ecological zone

Mountain7 VDCs

Hills7 VDCs

Terai7 VDCs

Mountain21 Wards

Hills21 Wards

Terai21 Wards

Collect data on VDC and ward characteristics, & household members with married women <30 y/o & women with children <5 y/o

Randomly select 7 VDCs using systematic random sampling

Randomly select 3 wards per VDC

Demographic and

Socioeconomic

Agriculture and

Food Security

Gender Roles and

Dynamics

Diet and Nutrition Health

Household

composition,

indicators of

wealth, assets,

income, livelihood

activities, social

participation,

water and

sanitation, access

to health services

Activities,

production and

sale, labor,

utilization of

technologies and

management

practices,

household food

security

Women’s role in

agriculture;

access, ownership,

and control of

assets, production,

and income;

decision-making;

time use; access to

agricultural and

nutritional

information

Diet recalls

(Caregiver and

index child),

anthropometry,

anemia, infant and

young child

feeding practices

Recent morbidity,

hygiene, utilization

of health

interventions and

services (antenatal

care, family

planning, bednets,

etc)

• Coverage and intensity of exposure to a program

within target populations at different life cycle stages

(peri-conception, pregnancy, and the first two years

of life)

• 3600 Households

• Sampling (12 sites)

– Community Connector (CC) sub-counties

– Non CC sub-counties

– Sub-counties in CC districts with no implementation

Observational Birth Cohort in Uganda

Maternal health

and nutrition, anemia,

Birth Weight

Maternal nutrition

Infant health and nutrition

WASH, health-sector, agriculture, livelihoods

Program exposure and uptake

Complementary Feeding

practices

Anthropometry

3 6 9 12 15 18 21

Age in MONTHS

CC District, CC sub-county-

contingent on exposure

non CC District

He

igh

t fo

r a

ge

Z s

core

Biomarkers: aflatoxins, IGF 1,

Vitamin A and iron markers,

inflammation markersCC District, non CC sub-county

What was

learned?

Effective

transmission?

Fidelity of

transmission?

Effective

integration?

Effective

transmission?

What was

learned?

Effectively

applied?

13

World Bank (2010) What can we learn from

nutrition impact evaluations? Washington, D.C.

Research on Coordinated delivery of Services, inputs and ideas

to improve nutrition

Central

District

VDC

Ward

Community

Household

Exposure, uptake, adherence,

outcomes

Effective cross sectoral

coordination,

challenges/constraints, capacities

http://www.3ieimpact.org/en/blog/2013/02/12/using-causal-

chain-make-sense-numbers/

Source: Murray and Frenck 2008 Lancet

Nutrition outcomes

� Stunting <24m, <59m

� Stunting dynamics (wasting episodes, growth spurts,

<6m trajectories, catch-up recovery)

� Nutrient deficiency interactions

� Maternal nutrition (beyond BMI)

Other outcomes

� Factor productivity gains via agriculture

� Food system quality (mycotoxins, pesticide residues)

� Environmental contaminants (ecoli, gut biota)

� Net nutrient value-added to consumer (new foods)

� Distribution of gains (quintile distribution of impacts)

Front-line public services

� Coverage, intensity, fidelity of agr. extension,

health service, social mobilization, etc.

Resource inputs

� Flow of budgets

� Human knowledge, attitudes, practices

Impact on a biological marker/indicator/metric – likely to have biological origins

• Stagnant and Contaminated Water– Diarrhea, Enteropathies

– Malaria

– Hookworm

– Human Microbiome

• Human and Animal Interactions (Microbiome)

• Food Safety: Mycotoxins, aflatoxins, stunting, immune response

• Exposure– Heavy metals

– Pesticide- What are the effects of pesticide exposure on maternal outcomes?

– Air Pollutants/BioMass