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Study Overview

Targeting and Realigning Agriculture for Improved Nutrition (TRAIN)
Study ID:
Initial Registration Date:
Last Update Date:
Study Status:
In Development
The proposed study will address key evidence gaps on the effects of integrated agriculture nutrition interventions on maternal and child nutrition. In particular, we will design and implement a four arm randomized controlled trial in rural Bangladesh that incorporates a strong state-of-the-art maternal and child health and nutrition behavior change communication (BCC) intervention, nutrition sensitive agriculture (NSA) extension services and a male sensitization component into an existing agricultural credit program in an additive manner. The first arm will only receive the agriculture credit intervention, the second arm will receive agriculture credit along with nutrition BCC, the third will receive agriculture credit, nutrition BCC as well as NSA extension and the fourth group will also receive male sensitization in addition to the three components mentioned. The impact evaluation will compare maternal and child nutrition outcomes between the various arms. Therefore, this impact evaluation will not only measure the impact of adding the nutrition BCC to the agricultural credit program, it will also assess the impact of these additional components on maternal and child nutrition.
Agriculture and Rural Development
Health, Nutrition, and Population
Water and Sanitation
Additional Keywords:
women's empowerment, maternal nutrition, child nutrition
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Principal Investigator(s)

Name of First PI:
Marie Ruel
Name of Second PI:
Neha Kumar

Research Partner

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Intervention Overview

The intervention, implemented by Building Resources Across Communities (BRAC), will consist of four components offered in an additive manner across the intervention arms. The base intervention is an agricultural credit program to boost agricultural incomes of tenant farmers by providing them with loans to undertake agriculture-related investments, all four arms will receive this. This base intervention will be layered with BCC messages around maternal and child health and nutrition (arms 2, 3 and 4); NSA extension services (arms 3 and 4) and male sensitization (arm 4). The objective of the NSA extension service is to encourage households to produce foods that are nutritious. It will consist of training households on how to farm certain, crops, fruits and vegetables, as well as animal rearing. The NSA extension services will also provide access to information on inputs and markets. The male sensitization will be focused on increasing awareness of the need to support women in their productive and reproductive roles and to help protect their time, health and nutrition and help men understand their roles as fathers and promoters of good health and nutrition for their family.
Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
BRAC Bangladesh
Type of Organization:
NGO (International)

Intervention Timing

Intervention or Program Started at time of Registration?
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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
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Additional Evaluation Method (If Any):
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Method Details

Details of Evaluation Approach:
Our estimation strategy will rely on the randomization of clusters across treatment arms. In this study, union (an administrative units consisting of 10 villages) is the cluster. Within each cluster we will identify all eligible households (defined as having a female member who has a loan from the agriculture credit program and having a married female member 15-28 years old) and then randomly draw 35 households who will be part of the intervention. Random assignment of clusters assures that, on average, households will have similar baseline characteristics across the different arms. Such a design eliminates systematic differences between households in different arms and minimizes the risk of bias in the impact estimates due to “selection effects”. Moreover, we will take advantage of the baseline survey and estimate the treatment effect using Analysis of Covariance (ANCOVA) which controls for the lagged outcome variable. Given the high variability and low autocorrelation of many of our outcomes, ANCOVA estimates are preferred over difference-in-difference estimates. The impact assessment will be based on two surveys: baseline household survey and endline household survey (panel).
Outcomes (Endpoints):
Primary Outcomes for this study include: Women’s Body Mass Index (BMI) and dietary diversity. Secondary outcomes include: Women’s hemoglobin, anemia prevalence, vitamin A status, Child dietary diversity and other IYCF practices and anthropometry ( Height-for-Age (HAZ), Weight-for-Height (WHZ) and Weight-for-Age(WAZ) Z-scores, stunting, wasting, underweight and mid-upper arm circumference for children), household welfare (agricultural production, asset ownership, consumption expenditure, household dietary diversity), women’s and men’s empowerment, women’s and men’s knowledge about maternal and child nutrition, IYCF practices, sanitation and hygiene. Hemoglobin and anemia prevalence and anthropometry outcomes constitute the final outcomes whereas the others constitute the intermediate outcome variables.
Unit of Analysis:
Married women in the age group 15-28 years old.
The agricultural credit program is intended to increase availability and access to food quantity and quality- either through increased income or diversified own production. The nutrition BCC is expected to improve knowledge and practices. The agriculture credit and nutrition BCC together will affect consumption patterns as well as practices that relate to child feeding, maternal care (pre and postnatal) as well as hygiene and sanitation. If households alter their consumption patterns towards a more nutritious diet, follow preventive health measures (for women before/during and after pregnancy as well as for children) and follow the right IYCF practices along with improved hygiene and sanitation- this should lead to better anthropometric outcomes. It is important to have improvements in all these intermediate outcomes before we can observe improvements in anthropometric measures.
Unit of Intervention or Assignment:
The intervention is randomized at the union level. A union is an administrative unit which consists of approximately 10 villages.
Number of Clusters in Sample:
Number of Individuals in Sample:
5040 women (and their households)
Size of Treatment, Control, or Comparison Subsamples:
This intervention will have four groups (arms) each with 36 clusters (unions)- each group will have 1260 households.

Supplementary Files

Analysis Plan:
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Outcomes Data

The impact evaluation will be based on a panel survey of households with an index woman (married woman 15-28 years old randomly selected within the household). The panel survey will also be administered to their husbands and will collect information on demographic characteristics, socioeconomic status, production, consumption, knowledge and practices related to IYCF, hygiene and sanitation, empowerment, anthropometry. We will also collect blood samples to determine hemoglobin among the women.
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Treatment Assignment Data

Participation or Assignment Information:
Once the baseline survey data collection is complete. We will randomly allocate the 144 unions into the four arms of the intervention.
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Data Analysis

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Study Materials

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Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected

Completion Overview

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Preliminary Report:
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Data Availability

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Other Materials

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Description of Changes:

Study Stopped