Women supporting mothers to improve feeding for infants and young children in Rahim Yar Khan

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

This program will try a 28-day, community-led feeding and hygiene approach led by local women to see if it improves nutrition for moderately malnourished children aged 7–15 months in Rahim Yar Khan, Pakistan.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 200 (estimated)
• Ages: 7 Months to 15 Months
• Sex: All
• Sponsor: University of British Columbia (Academic / other)
• Locations: 1 site (Rahim Yar Khan, Punjab Province)
• Trial ID: NCT07345754 on ClinicalTrials.gov

What this trial studies

The project uses an asset-based Positive Deviance Hearth approach combining community sensitization with a 28-day behaviour-change period and ongoing follow-up for six months. Eligible households with moderately malnourished children (weight-for-age Z-score between -2 and -3) attend town-hall sessions and daily interactive 'Hearth' sessions during the first two weeks, supported by visuals and printed materials. The intervention emphasizes practical complementary feeding, hygiene, and peer learning delivered by local women, with priority given to younger infants to allow longitudinal follow-up. Control clusters continue usual feeding practices and any severely malnourished children are referred to local health services.

Who should consider this trial

Good fit: Ideal candidates are households in Rahim Yar Khan classified as poor or very poor with access to clean water and sanitation who have a moderately malnourished child aged 7–15 months and are food secure at enrollment.

Not a fit: Severely malnourished children and households lacking basic water/sanitation or who are food insecure are unlikely to benefit from this program and will be referred or excluded.

Why it matters

Potential benefit: If successful, the program could help more children gain weight and improve feeding practices, reducing moderate malnutrition in participating communities.

How similar studies have performed: Positive Deviance Hearth and other community-based feeding programs have shown mixed but often positive effects on feeding practices and child weight in low-resource settings, with outcomes depending on local context and implementation quality.

Eligibility criteria

Inclusion Criteria:

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:

1. Mother is the primary caregiver for the Index Child (responsible for daily care, including supervision, bathing, and feeding).
2. Mother is alive and at least 18 years old.
3. Mother is currently breastfeeding the Index Child and willing to continue until the child reaches 2 years of age.
4. Mother expresses an interest in participating in the PD/Hearth program.
5. Mother agrees to attend up to three Hearth sessions.
6. 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).
7. Mother provides permission for study follow-ups as outlined above.
8. 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).
9. Mother provides informed consent via thumbprint or written signature.

Exclusion Criteria:

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

Household-Level Exclusion:

• Households who do not meet the inclusion criteria.

Where this trial is running

Rahim Yar Khan, Punjab Province

• Ryk — Rahim Yar Khan, Punjab Province, Pakistan (Recruiting)

Study contacts

• Study coordinator: Rosemin Kassam, Ph.D

Conditions Malnutrition in Children; 28-day behaviour change program; Positive Deviance Hearth; Malnutrition; Feeding parctices; Pakistan