Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): Study Protocol for a Five-arm, Cluster-randomized Trial

Overview

Journal Trials

Publisher Biomed Central

Specialties General Medicine
Pharmacology

Date 2024 Mar 15

PMID 38486278

Affiliations

Soon will be listed here.

Abstract

Background: Globally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers.

Methods: Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers' groups, with or without fathers' groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers' and fathers' groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers' groups receiving a nutrition program, (2) mothers' groups receiving a bundled nutrition and parenting program, (3) mothers' and fathers' groups receiving a nutrition program, (4) mothers' and fathers' groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention).

Discussion: EFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes.

Trial Registration: ClinicalTrials.gov NCT03759821. Registered on November 30, 2018.

Citing Articles

Food purchase diversity is associated with market food diversity and diets of children and their mothers but not fathers in rural Tanzania: Results from the EFFECTS baseline survey.

OMalley S, Ambikapathi R, Boncyk M, Mosha D, Verissimo C, Galvin L Matern Child Nutr. 2024; 21(1):e13734.

PMID: 39449138 PMC: 11650043. DOI: 10.1111/mcn.13734.

References

McCoy D, Sudfeld C, Bellinger D, Muhihi A, Ashery G, Weary T . Development and validation of an early childhood development scale for use in low-resourced settings. Popul Health Metr. 2017; 15(1):3. PMC: 5301363. DOI: 10.1186/s12963-017-0122-8. View

Black R, Victora C, Walker S, Bhutta Z, Christian P, de Onis M . Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382(9890):427-451. DOI: 10.1016/S0140-6736(13)60937-X. View

DiGirolamo A, Stansbery P, Lungaho M . Advantages and challenges of integration: opportunities for integrating early childhood development and nutrition programming. Ann N Y Acad Sci. 2014; 1308:46-53. DOI: 10.1111/nyas.12323. View

Dumbaugh M, Tawiah-Agyemang C, Manu A, ten Asbroek G, Kirkwood B, Hill Z . Perceptions of, attitudes towards and barriers to male involvement in newborn care in rural Ghana, West Africa: a qualitative analysis. BMC Pregnancy Childbirth. 2014; 14:269. PMC: 4137075. DOI: 10.1186/1471-2393-14-269. View

Engle P . The role of men in families: achieving gender equity and supporting children. Gend Dev. 1997; 5(2):31-40. DOI: 10.1080/741922351. View

Hoffmann T, Glasziou P, Boutron I, Milne R, Perera R, Moher D . Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014; 348:g1687. DOI: 10.1136/bmj.g1687. View

Briscoe C, Aboud F . Behaviour change communication targeting four health behaviours in developing countries: a review of change techniques. Soc Sci Med. 2012; 75(4):612-21. DOI: 10.1016/j.socscimed.2012.03.016. View

Chintalapudi N, Hamela G, Mofolo I, Maman S, Hosseinipour M, Hoffman I . Infant and Young Child Feeding Decision Making and Practices: Malawian Mothers' and Fathers' Roles in the Context of HIV. J Hum Lact. 2017; 34(1):68-76. PMC: 6667220. DOI: 10.1177/0890334417719245. View

Lu C, Black M, Richter L . Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health. 2016; 4(12):e916-e922. PMC: 5881401. DOI: 10.1016/S2214-109X(16)30266-2. View

10.

Britto P, Lye S, Proulx K, Yousafzai A, Matthews S, Vaivada T . Nurturing care: promoting early childhood development. Lancet. 2016; 389(10064):91-102. DOI: 10.1016/S0140-6736(16)31390-3. View

11.

Aboud F, Yousafzai A . Global health and development in early childhood. Annu Rev Psychol. 2014; 66:433-57. DOI: 10.1146/annurev-psych-010814-015128. View

12.

Doyle K, Levtov R, Barker G, Bastian G, Bingenheimer J, Kazimbaya S . Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial. PLoS One. 2018; 13(4):e0192756. PMC: 5884496. DOI: 10.1371/journal.pone.0192756. View

13.

Bilal S, Spigt M, Czabanowska K, Mulugeta A, Blanco R, Dinant G . Fathers' Perception, Practice, and Challenges in Young Child Care and Feeding in Ethiopia. Food Nutr Bull. 2016; 37(3):329-339. DOI: 10.1177/0379572116654027. View

14.

Ambikapathi R, Passarelli S, Madzorera I, Canavan C, A Noor R, Abdelmenan S . Men's nutrition knowledge is important for women's and children's nutrition in Ethiopia. Matern Child Nutr. 2020; 17(1):e13062. PMC: 7729551. DOI: 10.1111/mcn.13062. View

15.

Bich T, Hoa D, Malqvist M . Fathers as supporters for improved exclusive breastfeeding in Viet Nam. Matern Child Health J. 2013; 18(6):1444-53. DOI: 10.1007/s10995-013-1384-9. View

16.

Black M, Walker S, Fernald L, Andersen C, DiGirolamo A, Lu C . Early childhood development coming of age: science through the life course. Lancet. 2016; 389(10064):77-90. PMC: 5884058. DOI: 10.1016/S0140-6736(16)31389-7. View

17.

Bilal S, Dinant G, Blanco R, Crutzen R, Mulugeta A, Spigt M . The influence of father's child feeding knowledge and practices on children's dietary diversity: a study in urban and rural districts of Northern Ethiopia, 2013. Matern Child Nutr. 2014; 12(3):473-83. PMC: 6860103. DOI: 10.1111/mcn.12157. View

18.

Jeong J, Siyal S, Fink G, McCoy D, Yousafzai A . "His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan. BMC Public Health. 2018; 18(1):1274. PMC: 6245824. DOI: 10.1186/s12889-018-6143-9. View

19.

Drysdale R, Slemming W, Makusha T, Richter L . Father involvement, maternal depression and child nutritional outcomes in Soweto, South Africa. Matern Child Nutr. 2021; 17 Suppl 1:e13177. PMC: 8269140. DOI: 10.1111/mcn.13177. View

20.

Prado E, Larson L, Cox K, Bettencourt K, Kubes J, Shankar A . Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis. Lancet Glob Health. 2019; 7(10):e1398-e1413. DOI: 10.1016/S2214-109X(19)30361-4. View