RecruitingNot ApplicableNCT07345754

Women Supporting Women to Improve Infant and Child Feeding Practices in Pakistan

Women Supporting Women Using Local Solutions to Improve Infant and Young Child Feeding and Care Practices in Punjab, Pakistan

Sponsor

University of British Columbia

Enrollment

200 participants

Start Date

Oct 1, 2025

Study Type

INTERVENTIONAL

Conditions

Malnutrition in Children

Summary

This project aims to reduce child malnutrition in Pakistan by building on local strengths and practical community solutions. The project focuses on children 7-23 months of age. The investigators will aim to recruit young children between 7-15 months of age, giving the youngest children priority over older children so that participants may be followed longitudinally over 6 and 12 months. The project supports participants for six months through learning, practice, and regular follow-up. The work begins with community sensitization events, where local families learn about healthy feeding for young children through group discussions, visuals, and printed materials. These sessions build awareness, encourage community support, and prepare families for the main intervention. The core of the project is a 28-day behaviour change program. In the first two weeks, mothers and children take part in daily "Hearth" sessions, which are interactive, home-like meetings that teach practical feeding, hygiene, and caregiving skills using local foods. In the next two weeks, mothers apply learned skills at home while being visited regularly by project staff, who provide support and monitor child growth. If children gain at least 400 grams, as recommended by WHO, families graduate to monthly check-ins; if not, families may repeat the 28-day cycle up to three times. This approach targets chronic malnutrition by supporting families in adopting sustainable caregiving practices rather than providing short-term aid. Educational materials developed with community input support the learning process. Designed with visuals and minimal text, the materials are accessible to both literate and illiterate parents and are distributed widely to encourage shared responsibility for child health. To measure success, the project uses surveys and growth measurements for both treatment and control groups. Surveys gather information about family demographics, feeding and hygiene behaviours, and health practices, while trained staff measure children's height and weight at regular intervals. The data will help determine whether the intervention improves children's nutritional status and caregiving practices. Ultimately, the project seeks to empower families and communities to use local resources and knowledge to support healthier child growth. The project combines community engagement, hands-on learning, and scientific evaluation to promote lasting change in how families feed, nurture, and care for young children.

Eligibility

Min Age: 7 MonthsMax Age: 15 Months

Inclusion Criteria26

Eligible participants must meet all of the following conditions:
Child-Level Criteria:
While children in the intervention phase will range from ages 7-23 months, At the time of recruitment children will range from Ages: 7-15 months.
Priority will be given to younger children, aged 7-11 months, followed by 12-15 months to allow completion of the intervention and follow-up visits before the child turns 24 months of age, as complementary feeding refers to feeding practices between the ages of 6-24 months.
Moderate malnutrition, defined by: Weight-for-age Z-score between -2 and -3 standard deviations.
Household-Level Criteria:
Households will be eligible to participate if:
They meet the classification of very poor or poor (based on community-defined wealth stratification).
Have access to clean water and sanitation.
Food secure at time of recruitment, defined as:
On government assistant program or at least one adult has permanent employment, or two or more have temporary employment.
Ownership of at least one simple livestock (e.g., chicken, goat, or sheep) or express willingness to accept and care for livestock provided by the project team.
Access to a kitchen garden, or willingness to establish one with study support
Mother Eligibility Criteria:
The household is eligible only if the mother meets all of the following:
Mother is the primary caregiver for the Index Child (responsible for daily care, including supervision, bathing, and feeding).
Mother is alive and at least 18 years old.
Mother is currently breastfeeding the Index Child and willing to continue until the child reaches 2 years of age.
Mother expresses an interest in participating in the PD/Hearth program.
Mother agrees to attend up to three Hearth sessions.
Mother is willing and able to contribute to one of the following for Hearth sessions:
"Special" food items (e.g., apple, banana, carrot, chickpea, egg, garlic, lentils, rice, spinach, tomato, etc.), or
Other essential items (e.g., utensils, bowls, spoons, soap, nail cutter, towels, water, mat, salt, matchstick).
Mother provides permission for study follow-ups as outlined above.
Mother agrees to a full medical check-up for the Index Child at the nearest public health facility, including a one-time hematocrit finger-prick test (Hb test).
Mother provides informed consent via thumbprint or written signature.

Exclusion Criteria11

Child-Level Exclusions:
Children who are Severely malnourished, mildly underweight or of normal weight.
Children with Physical disabilities: difficulty in seeing, hearing, picking up small objects with his/her hand.
Children with chronic illnesses that may interfere with normal growth (based on past or current medical history):
Malabsorption
Chronic Kidney Disease
Inflammatory Bowel Disease
Congenital Heart Disease
Endocrine Disorders (e.g., hypothyroidism, growth hormone deficiencies)
Chronic Respiratory Diseases (e.g., asthma, lung diseases)
Congenital or Acquired Immunodeficiency, and Neurological Disorders

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Interventions

BEHAVIORAL28-day Behavioural Change Program

The study's intervention includes a 28-day program with group sessions in a home-like setting (Hearth) where mothers of moderately malnourished children and family members learn practical ways to prepare nutritious meals and improve caregiving practices. Each cycle has two parts: Group Hearth Sessions (2 weeks): About 15 mother-child pairs attend sessions. Sessions will focus on knowledge about complementary feeding, active feeding, hygiene, caregiving, and health-seeking behaviours. Mothers will take part in cooking and caring demonstrations, rotating through roles to build hands-on skills. Home Practice (2 weeks): Field staff visit each home three times per week to reinforce new behaviours, provide guidance, and monitor progress. Mothers contribute small items such as eggs, rice, or utensils to reflect real-life conditions, while the project provides pots, utensils, and most of the food. This shared approach promotes engagement and helps sustain improved practices at home.