World Bank Document
Total Page：16
File Type：pdf, Size：1020Kb
An integrated parenting, nutrition and malaria prevention package to improve nutrition and child development in infants and pre-school children: Public Disclosure Authorized Impact evaluation of a randomized controlled trial in southern Mali Public Disclosure Authorized Public Disclosure Authorized Endline Report for World Bank Strategic Impact Evaluation Fund December 2017 Public Disclosure Authorized in collaboration with: 1 World Bank Task Team Leader: Pierre Joseph Kamano, Senior Education Specialist The World Bank, Mali Country Office [email protected] Implementing Agency: Save the Children and national partners Impact Evaluation Team: Natalie Roschnik (co-PI) Save the Children International e-mail: [email protected] Siân Clarke (co-PI) London School of Hygiene and Tropical Medicine, UK e-mail: [email protected] Moussa Sacko (co-investigator) Institut Nationale de Recherche en Santé Publique, Mali Yvonne Griffiths (co-investigator) University of Leeds, UK Josselin Thuilliez (co-investigator) Centre d’economie de Sorbonne, Paris, France Niélé Hawa Diarra (project manager) Save the Children, Sikasso, Mali National and international collaborators: - Philippe Thera Save the Children, Sikasso, Mali - Yahia Dicko Save the Children, Sikasso, Mali - Kalifa Sidibé Save the Children, Sikasso, Mali - Modibo Bamadio Save the Children, Bamako, Mali - Renion Saye Institut National de Recherche en Santé Publique (INRSP), Mali - Hamidou Niangaly Malaria Research and Training Center, Université de Bamako, Mali - Maria Sangaré Direction Nationale de l’Education Préscolaire et Spéciale, Mali - Aissata Traoré Direction Nationale de l’Education Préscolaire (DNEP), Mali - Bonaventure Maiga Ministère de l’éducation, Bamako, Mali - Fatoumata Dougnon Direction Nationale de la Santé (DNS), Division Nutrition, Mali - Mamadou Traoré Direction Nationale de la Santé (DNS), Division Nutrition, Mali - Seybou Guindo Direction Nationale de la Santé (DNS), Division Nutrition, Mali - Mouctar Coulibaly Institut Polytechnique Rural de Formation et de Recherche Appliquee (IPR/IFRA), Bamako/Katibougou, Mali - Bore Saran Diakité Programme National de Lutte contre le Paludisme (PNLP), Mali - Rebecca Jones University College London, London, United Kingdom - Hans Verhoef LSHTM, UK and Wageningen University, The Netherlands - Michael Boivin Michigan State University, USA - Lauren Pisani Save the Children International, Washington, USA. | P a g e 2 ACKNOWLEDGEMENTS The research team would like to thank the World Bank Strategic Impact Evaluation Fund (SIEF) for its generous grant to support this study; UBS Optimus Foundation and Save the Children Switzerland for co-funding the baseline surveys. We would also like to thank Sight and Life and Unicef for donating the micronutrient powders; and Save the Children’s sponsorship program for supporting the implementation of the program in Mali and additional survey related costs. We would like to thank our national research and implementation partners for their ongoing engagement and support throughout the study: the INRSP for leading the research and conducting the biomedical survey; the PNLP for conducting the seasonal malaria chemoprevention; the DNS Nutrition Division for supporting the MNP related guidance and materials development; the IGEN and DNEP for supporting the ECD elements of the study and the MRTC and IPR/IFRA for ongoing advice and support on the malaria and nutrition aspects of the study. We also thank the international research partners, particularly the London School of Hygiene & Tropical Medicine, UK for designing the study and leading the research and data analyses; Michigan State University, USA, University of Leeds and University College London, UK for additional advice on the evaluation of cognitive outcomes and data analysis; and Save the Children USA’s research team for its support with IDELA and data analysis. We would like most of all to thank the Save the Children Team in Mali for implementing the interventions and coordinating the evaluation on the ground. Lastly, we would like to thank our district and regional level health, nutrition and education partners for supporting the interventions and surveys, the mairies, ECD Center facilitators, village leaders, parents and the children themselves for taking part in the research | P a g e 3 Table of contents INTRODUCTION ............................................................................................................................. 7 I. Background to The Project ................................................................................................... 7 II. Context and Justification ...................................................................................................... 8 METHODS ....................................................................................................................................... 12 III. The Interventions ............................................................................................................... 12 IV. Research Hypothesis........................................................................................................... 14 V. Objectives .......................................................................................................................... 15 VI. Study Area and Population ................................................................................................ 16 VII. Impact Evaluation Design .................................................................................................. 18 VIII. Data Collection and Indicators ........................................................................................... 22 a. Measurement of biomedical outcomes ........................................................................... 22 b. Measurement of cognitive outcomes and indicators of school readiness ........................ 23 IX. Statistical Analysis ............................................................................................................... 28 X. Sample Size ........................................................................................................................ 30 XI. Process Evaluation ............................................................................................................. 33 XII. Cost Analysis ...................................................................................................................... 35 XIII. Ethical Considerations ........................................................................................................ 41 RESULTS .......................................................................................................................................... 43 XIV. Implementation and Uptake of the Interventions ............................................................... 43 XV. Impact on Intermediate Outcomes ..................................................................................... 59 XVI. Impact on Biomedical Outcomes........................................................................................ 65 a. Effect on biomedical outcomes in children aged 5 years ................................................ 69 b. Effect on biomedical outcomes in children aged 3 years ................................................ 71 XVII. Impact on Cognitive Function ........................................................................................... 73 a. Effect on cognitive outcomes and school-readiness in children aged 5 years .................. 73 b. Effect on cognitive outcomes in children aged 3 years ................................................... 74 XVIII. Cost Analysis ...................................................................................................................... 75 DISCUSSION ................................................................................................................................... 79 REFERENCES ................................................................................................................................. 85 ANNEXES........................................................................................................................................ 89 Annex I. MNP Powders used .......................................................................................................... 89 Annex II. Intervention - Key Messages ............................................................................................ 89 Annex III. Adapting the cognitive and child development assessments for use in Mali ...................... 93 Annex IV. Research Team ................................................................................................................ 97 Annex V. Ethics Approvals ........................................................................................................... 103 Annex VI. Household Questionnaire .............................................................................................. 105 | P a g e 4 Annex VII. Biomedical questionnaire ....................................................................................... 116 Annex VIII Supplementary table S1 ......................................................................................... 118 | P a g e 5 ACRONYMS DNP Direction Nationale de Pedagogie ECD Early Childhood Development GCP Good Clinical Practice HSKT Head Shoulders Knees and Toes test IDELA International Development and Early Learning Assessment