Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Shibani Ghosh, Tufts University "Studying Effectiveness: considerations in research design and implementation"


Published on

Science Forum 2013 (
Plenary session: Evaluating nutrition and health outcomes of agriculture
Shibani Ghosh, Tufts University: case study presentation

Published in: Technology, Health & Medicine
  • Be the first to comment

  • Be the first to like this

Shibani Ghosh, Tufts University "Studying Effectiveness: considerations in research design and implementation"

  1. 1. Studying effectiveness: Considerations in research design and implementation Shibani Ghosh Feed the Future Innovation Laboratory for Collaborative Research on Nutrition
  2. 2. 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
  3. 3. 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)
  4. 4. 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”
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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)
  9. 9. • 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
  10. 10. 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
  11. 11. What was learned? Effective transmission? Fidelity of transmission? Effective integration? Effective transmission? What was learned? Effectively applied?
  12. 12. 13 World Bank (2010) What can we learn from nutrition impact evaluations? Washington, D.C.
  13. 13. 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
  14. 14. chain-make-sense-numbers/
  15. 15. 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
  16. 16. 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