Peer-reviewed article
A cluster randomized controlled trial of a community‐based initiative to reduce stunting in rural Indonesia
Amanda Beatty, Evan Borkum, William Leith, Clair Null, Wayan Suriastini ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study tested a $120 million community-based project in rural Indonesia (2014 to 2018) that aimed to reduce child stunting. The project combined community grants for health and education, training for health providers on feeding and growth monitoring, and training for sanitarians on community-led total sanitation. It was tested in 95 treatment and 95 control subdistricts using a cluster randomized trial. About a year after the project ended, there was no significant effect on stunting or other longer-term undernutrition outcomes. Some nearer-term maternal and child nutrition outcomes improved, while others did not change.
Key points
- No significant impact on stunting, the primary outcome (0.5 percentage points; 95% CI: −3.0 to 4.1).
- Mothers consuming the recommended number of iron-folic acid pills during pregnancy rose by 8.7 percentage points (95% CI: 4.1 to 13.3).
- Exclusive breastfeeding among 0–5-month-olds rose by 8.7 percentage points (95% CI: 1.8 to 15.6).
- 6–23-month-olds receiving the recommended number of meals per day rose by 8.5 percentage points (95% CI: 3.8 to 13.2).
- No significant effects on prenatal and postnatal checkups, child dietary diversity, vitamin A receipt or child diarrhoea.
Limitations
The abstract does not explain why the project had limited effects or give details on how well each component was implemented. Results come from three Indonesian provinces and measure outcomes about one year after the project ended, so they may not apply elsewhere or show later effects.
Abstract
AbstractWe evaluate the impacts of a $120 million project in Indonesia conducted between 2014 and 2018 that sought to reduce stunting through a combination of (1) community‐driven development grants targeted at health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring and (3) training for sanitarians on a local variation of community‐led total sanitation. This cluster randomized controlled trial involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. Overall, we find no significant impacts on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: −3.0 to 4.1 percentage points [pp]), or other longer‐term undernutrition outcomes about 1 year after the end of the project. The project had a modest impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron‐folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1–13.3 pp), 0–5‐month‐olds being exclusively breastfed (8.7 pp; 95% CI: 1.8–15.6 pp) and 6–23‐month‐olds receiving the number of recommended meals per day (8.5 pp; 95% CI: 3.8–13.2 pp). However, there were no significant impacts on other proximal outcomes like the number of pre‐natal and post‐natal checkups, child dietary diversity, child vitamin A receipt or the incidence of child diarrhoea. Our findings highlight that successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice. Project design needs to consider implementation reality along with best practice—for example, by piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually over a longer timeframe.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- An integrated package of community-driven development grants targeting health and education outcomes, training for health providers on infant and young child feeding and growth monitoring, and training for sanitarians on a local variation of community-led total sanitation
- Population
- Communities in 190 subdistricts (95 treatment, 95 control) across South Sumatra, West Kalimantan and Central Kalimantan provinces, Indonesia, including mothers and young children
Key finding
No significant impact on stunting (0.5 pp; 95% CI: −3.0 to 4.1) or other longer-term undernutrition outcomes.
Beatty et al. · Crossref · 2 Dec 2023