This document discusses considerations for research design and implementation to study the effectiveness of nutrition programs. It describes plans to conduct an observational study with randomized site selection in Nepal and Uganda to examine the impact of multiple existing nutrition programs. The study will collect annual panel survey and cohort data on demographics, agriculture/food security, gender roles, diet/nutrition, and health from 4,500 households across different ecological zones and exposure levels to nutrition programs. Key outcomes of interest include nutrition status, maternal and child health, and exposure/uptake of various sectoral interventions related to agriculture, health, and livelihoods. The document emphasizes understanding effective cross-sectoral coordination and transmission of programs to end users.

1. Studying effectiveness: Considerations in
research design and implementation
Shibani Ghosh
Feed the Future
Innovation Laboratory
for Collaborative Research on Nutrition

3. Community
Connector
programme
Maternal/Child
Nutrition
ENA and
EHA
Agricultural and
post harvest
Technologies
Risk management,
Micro-credit
Savings
Service
Quality
Income,
Health
Diet
Quality
??
Gender
approaches
Sectoral
coordintn
?
80,000
households
15 districts of
Uganda

4. Suaahara FTF program
Diet
Quality
Maternal/Child
Nutrition
ENA/EHA
Home
gardens
Agric.
Extension
Service
Quality
New
seeds
Irrigation
Diet
Quantity
(and
Quality)
Rural
finance
??
Poultry,
goats
Sectoral
coordintn
Suaahara (25 districts), Feed the Future (20 districts)

5. Research Design Considerations
Randomized control trial (RCT)
Number of treatments (single and combination)
Ability to detect differences between treatments
Resource and management scope
Research design around existing program
design
Purposive selection of districts
Non randomized roll out
Co-existence of multiple programs
Question of “how” and not “what”

6. Research Design
Observational
Randomized site selection with counterfactuals
and pre-post in Nepal and Uganda
Observational cohort annual panel survey and
Longitudinal sentinel sites in Nepal
Cohort panels and quasi experimental
longitudinal birth cohort in Uganda

7. Policy and Programmatic considerations
Suaahara (25 districts), Feed the Future (20 districts)
GAFSP (7 districts), Multisectoral Nutrition Plan (incremental roll-out; from
6 districts in Year 1 to 75 by Year 5), Sunaula Hazar Din “Golden First 1000
Days” (15 districts)……
4500 households
Surveillance system to assess program response to agriculture,
health & nutrition programs in Nepal: annual panel surveys and
sentinel sites

8. Mountain
543 VDCs
Hills
2,034 VDCs
Terai
1,394 VDCs
List Districts from west-to-east and VDCs alphabetically within
each district by ecological zone
Mountain
7 VDCs
Hills
7 VDCs
Terai
7 VDCs
Mountain
21 Wards
Hills
21 Wards
Terai
21 Wards
Collect data on VDC and ward characteristics, & household members
with married women <30 y/o & women with children <5 y/o
Randomly select 7 VDCs using
systematic random sampling
Randomly select 3 wards per VDC

9. Demographic and
Socioeconomic
Agriculture and
Food Security
Gender Roles and
Dynamics
Diet and Nutrition Health
Household
composition,
indicators of
wealth, assets,
income, livelihood
activities, social
participation,
water and
sanitation, access
to health services
Activities,
production and
sale, labor,
utilization of
technologies and
management
practices,
household food
security
Women’s role in
agriculture;
access, ownership,
and control of
assets, production,
and income;
decision-making;
time use; access to
agricultural and
nutritional
information
Diet recalls
(Caregiver and
index child),
anthropometry,
anemia, infant and
young child
feeding practices
Recent morbidity,
hygiene, utilization
of health
interventions and
services (antenatal
care, family
planning, bednets,
etc)

10. • Coverage and intensity of exposure to a program
within target populations at different life cycle stages
(peri-conception, pregnancy, and the first two years
of life)
• 3600 Households
• Sampling (12 sites)
– Community Connector (CC) sub-counties
– Non CC sub-counties
– Sub-counties in CC districts with no implementation
Observational Birth Cohort in Uganda

11. Maternal health
and nutrition, anemia,
Birth Weight
Maternal nutrition
Infant health and nutrition
WASH, health-sector, agriculture, livelihoods
Program exposure and uptake
Complementary Feeding
practices
Anthropometry
3 6 9 12 15 18 21
Age in MONTHS
CC District, CC sub-county-
contingent on exposure
non CC District
HeightforageZscore
Biomarkers: aflatoxins, IGF 1,
Vitamin A and iron markers,
inflammation markers
CC District, non CC sub-county

12. What was
learned?
Effective
transmission?
Fidelity of
transmission?
Effective
integration?
Effective
transmission?
What was
learned?
Effectively
applied?

13. 13
World Bank (2010) What can we learn from
nutrition impact evaluations? Washington, D.C.

14. Research on Coordinated delivery of Services, inputs and ideas
to improve nutrition
Central
District
VDC
Ward
Community
Household
Exposure, uptake, adherence,
outcomes
Effective cross sectoral
coordination,
challenges/constraints, capacities

15. http://www.3ieimpact.org/en/blog/2013/02/12/using-causal-
chain-make-sense-numbers/

16. Source: Murray and Frenck 2008 Lancet
Nutrition outcomes
Stunting <24m, <59m
Stunting dynamics (wasting episodes, growth spurts,
<6m trajectories, catch-up recovery)
Nutrient deficiency interactions
Maternal nutrition (beyond BMI)
Other outcomes
Factor productivity gains via agriculture
Food system quality (mycotoxins, pesticide residues)
Environmental contaminants (ecoli, gut biota)
Net nutrient value-added to consumer (new foods)
Distribution of gains (quintile distribution of impacts)
Front-line public services
Coverage, intensity, fidelity of agr. extension,
health service, social mobilization, etc.
Resource inputs
Flow of budgets
Human knowledge, attitudes, practices

17. Impact on a biological marker/indicator/metric – likely to
have biological origins
• Stagnant and Contaminated Water
– Diarrhea, Enteropathies
– Malaria
– Hookworm
– Human Microbiome
• Human and Animal Interactions (Microbiome)
• Food Safety: Mycotoxins, aflatoxins, stunting, immune
response
• Exposure
– Heavy metals
– Pesticide- What are the effects of pesticide exposure on
maternal outcomes?
– Air Pollutants/BioMass