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A Community Health Worker-Based Intervention on Anthropometric Outcomes of Children Aged 3 to 21 Months in Urban

Abu S Shonchoy1, Agha A Akram1, Mahrukh Khan1

  • 1Abu S. Shonchoy is with the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University, Miami. At the time of this work, Agha A. Akram was with the Department of Economics, Mushtaq Ahmad Gurmani School of Social Science, Lahore University of Management Sciences; Mahrukh Khan was with the Centre for Economic Research in Pakistan; Hina Khalid was with the Department of Economics, School of Humanities and Social Sciences, Information Technology University; and Sidra Mazhar was with the Center for Economic Research in Pakistan, Lahore, Pakistan. Akib Khan is with the Department of Economics, Uppsala University, Uppsala, Sweden. Takashi Kurosaki is with the Institute of Economic Research, Hitotsubashi University, Tokyo, Japan.

American Journal of Public Health
|December 14, 2022
PubMed

Insights

A community health worker intervention significantly improved child growth in Pakistan. The in-home growth monitoring with counseling (IHGMC) program showed lasting positive effects on children's height and weight.

Area of Science:

  • Public Health
  • Pediatrics
  • Global Health

Background:

  • Childhood stunting is a significant public health issue in Pakistan, affecting 38% of children under five.
  • Disadvantaged urban informal settlements often lack adequate resources for child growth monitoring and support.

Purpose of the Study:

  • To assess the effectiveness of an "in-home growth monitoring with counseling" (IHGMC) intervention delivered by community health workers.
  • To evaluate the impact of IHGMC on anthropometric outcomes in young children in Pakistan.

Main Methods:

  • An individual, single-blind, step-wedge randomized controlled trial with a pure control group was employed.
  • Intention-to-treat analysis used coarsened exact matching (CEM) for sample selection.
  • The study included 1639 households with children aged 3-21 months, with analysis on a CEM sample of 1046.

Main Results:

  • The IHGMC intervention resulted in a significant increase in height-for-age z-scores by 0.58 SD (P=.001).
  • Weight-for-age z-scores also improved significantly, increasing by 0.43 SD (P<.01).
  • These positive anthropometric changes were observed at the endline, 6 months post-intervention.

Conclusions:

  • The IHGMC intervention substantially improved child anthropometric outcomes in disadvantaged urban areas.
  • The positive impact of IHGMC on child growth was sustained even during the COVID-19 pandemic.

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