scholarly journals The evaluation of Suchana, a large-scale development program to prevent chronic undernutrition in north-eastern Bangladesh

2020 ◽  
Author(s):  
Nuzhat Choudhury ◽  
Mohammad Jyoti Raihan ◽  
S M Tanvir Ahmed ◽  
Kazi Eliza Islam ◽  
Vanessa Self ◽  
...  
Keyword(s):  
Large Scale ◽  
Development Program ◽  
Cluster Randomized Trial ◽  
Baseline Survey ◽  
Poor People ◽  
Poor Households ◽  
Service Delivery Systems ◽  
Administrative Unit ◽  
Cluster Randomized ◽  
The Impact

Abstract Evidence of the impact of community-based nutrition programs is uncommon for two main reasons: the lack of untreated controls, and implementation does not account for the evaluation design. Suchana is a large-scale program to prevent malnutrition in children in Sylhet Division, Bangladesh by improving the livelihoods and nutrition knowledge of poor and very poor households. Suchana is being implemented in 157 unions, the smallest administrative unit of government, in two districts of Sylhet. Suchana will deliver a package of interventions to poor people in about 40 randomly selected new unions annually over four years, until all are covered. All beneficiaries will receive the normal government nutrition services. For evaluation purposes the last 40 unions will act as a control for the first 40 intervention unions. The remaining unions will receive the program but will not take part in the evaluation. A baseline survey was conducted in both intervention and control unions; it will be repeated after three years to estimate the impact on the prevalence of stunted children and other indicators.This stepped wedge design has several advantages for both the implementation and evaluation of services, as well as some disadvantages. The units of delivery are randomized, which controls for other influences on outcomes; the program supports government service delivery systems, so it is replicable and scalable; and the program can be improved over time as lessons are learned. The main disadvantages are the difficulty of estimating the impact of each component of the program, and the geographical distribution of unions, which increases program delivery costs. Stepped implementation allows a cluster randomized trial to be achieved within a large-scale poverty alleviation program and phased-in and scaled-up over a period of time. This paper may encourage evaluators to consider how to estimate attributable impact by using stepped implementation, which allows the counterfactual group eventually to be treated.

scholarly journals The evaluation of Suchana, a large-scale development program to prevent chronic undernutrition in north-eastern Bangladesh: A large scale nutrition program design

2020 ◽  
Author(s):  
Nuzhat Choudhury ◽  
Mohammad Jyoti Raihan ◽  
S M Tanvir Ahmed ◽  
Kazi Eliza Islam ◽  
Vanessa Self ◽  
...  
Keyword(s):  
Service Delivery ◽  
Large Scale ◽  
Development Program ◽  
Baseline Survey ◽  
Control Group ◽  
Poor People ◽  
Stepped Wedge ◽  
Stepped Wedge Design ◽  
Cluster Randomized ◽  
The Impact

Abstract Background Evidence of the impact of community-based nutrition programs is uncommon for two main reasons: the lack of untreated controls, and implementation does not account for the evaluation design. Suchana is a large-scale program to prevent malnutrition in children in Sylhet Division, Bangladesh by improving the livelihoods and nutrition knowledge of very poor households.Methods Suchana is being implemented in 157 unions, the smallest administrative unit of government, in two districts of Sylhet. Suchana will deliver a package of interventions to poor people in about 40 randomly selected new unions annually over four years, until all are covered. All beneficiaries will receive the normal government nutrition services. For evaluation purposes the last 40 unions will act as a control for the first 40 intervention unions. The remaining unions will receive the program but will not take part in the evaluation. A baseline survey was conducted in both intervention and control unions; it will be repeated after three years to estimate the impact on the prevalence of stunted children and other indicators.Results This stepped wedge design has several advantages for both implementation and evaluation, as well as some disadvantages. The units of delivery are randomized, which controls for other influences on outcomes; the program supports government service delivery systems, so it is replicable and scalable; and the program can be improved over time as lessons are learned. The main disadvantages are the difficulty of estimating the impact of each component of the program, and the geographical distribution of unions, which increases program delivery costs. Stepped implementation allows a cluster randomized trial to be achieved within a large-scale poverty alleviation program.Conclusions A stepped wedge design for implementation was used which is particularly suited to evaluations of service delivery. The design allows the intervention to be phased-in and scaled-up over a period of time. The phased or ‘stepped’ process of implementation enables a cluster randomized controlled trial to be achieved without having a permanently untreated control group. However, the design does not allow to assess the impact of each individual component of intervention.

Impact of clinic characteristics on the adoption of a guideline-based standing order algorithm and patient accrual in the pragmatic cluster-randomized trial SWOG S1415CD (NCT02728596).

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 60-60
Author(s):  
Kate Watabayashi ◽  
Ari Bell-Brown ◽  
Kathryn Egan ◽  
Karma L. Kreizenbeck ◽  
Gary H. Lyman ◽  
...  
Keyword(s):  
Onset Time ◽  
Cluster Randomized Trial ◽  
Baseline Survey ◽  
Record System ◽  
Oncology Research ◽  
Standing Order ◽  
Cluster Randomized ◽  
Survey Responses ◽  
The Impact ◽  
Patient Accrual

60 Background: The S1415CD intervention requires the integration of guideline-based prescribing recommendations and standing orders for primary prophylactic colony stimulating factors into existing chemotherapy order systems at community practices within the National Cancer Institute’s Community Oncology Research Program. We looked at the impact of clinic level characteristics on the length of time needed to successfully adopt the intervention and subsequent patient accrual. Methods: We calculated the length of time between randomization and intervention completion for each intervention arm clinic and classified them as short onset (2-5 months, N = 5), medium onset (6-8 months, N = 12) or long onset (10-12 months, N = 7). We compared baseline survey responses about clinic characteristics to onset times. Results: Type of EMR software and the number of chemotherapy regimens reconfigured for the trial had no effect on onset time. All short and medium onset clinics placed orders through an EMR, while 5 of 7 long onset clinics used paper orders. Long onset clinics had less reported nurse involvement in the reconfiguration workflow (change initiation, approval, fulfillment and dissemination) at 14% of clinics vs. 25% of medium onset and 75% of short onset clinics. The average weekly patient accrual rates observed after intervention completion were 1.0 in the short onset (range 0.6-1.5), 0.8 in the medium onset (0.2-1.3) and 0.6 in the long onset (0.1-2.0). Conclusions: When recruiting clinics for trials that require health record system changes, it may be helpful to consider aspects of the system modification workflow such as type of hospital departments involved, as clinics with less nursing involvement may take longer to complete the changes. The inclusion of clinics using different EMR software did not impede onset, but clinics using paper may require more time. Length of onset had no meaningful impact on weekly accrual rates; however, it did determine when clinics could start recruitment, affecting the total number of months clinics could recruit during the study accrual period. Clinical trial information: NCT02728596.

scholarly journals Reopening schools safely in the face of COVID-19: Can cluster randomized trials help?

2021 ◽  
pp. 174077452098486
Author(s):  
Charles Weijer ◽  
Karla Hemming ◽  
Spencer Phillips Hey ◽  
Holly Fernandez Lynch
Keyword(s):  
Randomized Trials ◽  
Cluster Randomized Trial ◽  
Evidence Based ◽  
School Closures ◽  
School Aged Children ◽  
The Face ◽  
Community Transmission ◽  
Cluster Randomized ◽  
The Impact ◽  
Health Policymaking

The COVID-19 pandemic has highlighted the challenges of evidence-based health policymaking, as critical precautionary decisions, such as school closures, had to be made urgently on the basis of little evidence. As primary and secondary schools once again close in the face of surging infections, there is an opportunity to rigorously study their reopening. School-aged children appear to be less affected by COVID-19 than adults, yet schools may drive community transmission of the virus. Given the impact of school closures on both education and the economy, schools cannot remain closed indefinitely. But when and how can they be reopened safely? We argue that a cluster randomized trial is a rigorous and ethical way to resolve these uncertainties. We discuss key scientific, ethical, and resource considerations both to inform trial design of school reopenings and to prompt discussion of the merits and feasibility of conducting such a trial.

scholarly journals The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial

BMJ ◽  
2015 ◽  
Vol 350 (mar04 8) ◽  
pp. h1019-h1019 ◽  
Author(s):  
E. K. Ansah ◽  
S. Narh-Bana ◽  
H. Affran-Bonful ◽  
C. Bart-Plange ◽  
B. Cundill ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Retail Sector ◽  
Cluster Randomized ◽  
The Impact ◽  
Fever Management

scholarly journals Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial

2014 ◽  
Vol 19 (10) ◽  
pp. 1185-1197 ◽  
Author(s):  
Bethany A. Caruso ◽  
Matthew C. Freeman ◽  
Joshua V. Garn ◽  
Robert Dreibelbis ◽  
Shadi Saboori ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Nyanza Province ◽  
School Based ◽  
Cluster Randomized ◽  
The Impact

scholarly journals Pengaruh Pembangunan Perumahan Bagi Rumah Tangga Miskin (RTM) Terhadap Kondisi Sosial-Ekonomi Masyarakat Kelurahan Sawah Besar, Kecamatan Gayamsari, Kota Semarang

2016 ◽  
Vol 12 (3) ◽  
pp. 315
Author(s):  
Maharani Tri Hapsari
Keyword(s):  
Pearson Correlation ◽  
Descriptive Analysis ◽  
Development Program ◽  
Monitoring And Evaluation ◽  
Provincial Government ◽  
Poor People ◽  
Quantitative Descriptive Analysis ◽  
Average Percentage ◽  
Central Java ◽  
Poor Households

This research is motivated by the problems there is the number of poor people in Central Java who live in the houses not livable. Therefore, Central Java Provincial Government made a Housing Development Program for Poor Households. Central Java province has been conducting monitoring and evaluation of the program, but is only the aspect of a physicaly output, whereas according to the concept Tridaya that housing construction should also touching the social and economic conditions of society, so the researchers are interested in conduct research on how the influence of the development program of housing for poor households to the socio-economic condition of society in Kelurahan Sawah Besar, Kecamatan Gayamsari Kota Semarang. The research methodology used in this study is a mixture of qualitative and quantitative descriptive analysis with nonparametric statistical methods using statistical test of Wilcoxon different test as well as the influence of the Pearson correlation test using SPSS version 20. The conclusion is the average percentage of target accuracy analysis is based on the condition of households amounted to 31.50%, while the results of the analysis target accuracy of the condition of the house building is at 68.75 %. As a result of the implementation of the program is able to improve the physical condition by 55%, improving social conditions by 45%, but the economic outlook has decreased by 10%, due to a decrease in variable levels of spending, which is caused by the number of respondents who went into debt in the implementation of development / repair their house. Therefore, the need for revisions or changes in the criteria determining the target households, using of local wisdom, which is expected to generate empowerment in its implementation so as to avoid people from debt problems.

scholarly journals Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Amanda S Wendt ◽  
Jillian L Waid ◽  
Sabine Gabrysch
Keyword(s):  
Iron Deficiency ◽  
Vitamin C ◽  
Fruits And Vegetables ◽  
Iron Absorption ◽  
Cluster Randomized Trial ◽  
Heme Iron ◽  
Dietary Factors ◽  
Baseline Survey ◽  
Women And Children ◽  
Cluster Randomized

ABSTRACT Background Anemia affects ∼1.6 billion people worldwide, often owing to iron deficiency. In Bangladesh, high levels of anemia have been observed alongside little iron deficiency. Elevated concentrations of groundwater iron could constitute a significant source of dietary iron. Objective We aimed to quantify the effect of groundwater iron on anemia in nonpregnant women and young children in Bangladesh, taking into account dietary factors that may affect iron absorption. Methods We analyzed data on 1871 nonpregnant women and 987 children (6–37 mo) from the 2015 baseline survey of the Food and Agricultural Approaches to Reducing Malnutrition cluster-randomized trial in Sylhet, Bangladesh. We used logistic regression with robust standard errors to assess effects of self-reported groundwater iron, dietary intake, and sociodemographic characteristics on anemia, considering interactions between groundwater iron and dietary factors. Results Groundwater iron presence was associated with less anemia in women (OR: 0.74; 95% CI: 0.60, 0.90) and children (OR: 0.58; 95% CI: 0.44, 0.76). This effect was modified by dietary factors. In women, the effect of groundwater iron on anemia was stronger if no vitamin C–rich or heme-iron foods were consumed, and there was a clear dose–response relation. In children, intake of vitamin C–rich foods strengthened the effect of groundwater iron on anemia, and there was no evidence for interaction by intake of iron-rich foods. Conclusions Heme-iron and vitamin C consumption reduced the effect of groundwater iron on anemia among women but not children in Bangladesh, which may be due to higher levels of iron deficiency and lower levels of iron intake among children. Vitamin C consumption appears to enhance iron absorption from groundwater in children and they may thus benefit from consuming more vitamin C–rich fruits and vegetables. Even among women and children consuming heme-iron or vitamin C–rich foods and groundwater iron, anemia prevalence remained elevated, pointing to additional causes of anemia beyond iron deficiency. This trial was registered at clinicaltrials.gov as NCT02505711.

Reducing Physical Aggression in High School Students in KwaZulu-Natal: A Cluster Randomized Trial

2020 ◽  
Vol 35 (6) ◽  
pp. 861-884
Author(s):  
Myra Taylor ◽  
Benn Sartorius ◽  
Saloshni Naidoo ◽  
Hein de Vries
Keyword(s):  
High School Students ◽  
Randomized Trial ◽  
Youth Violence ◽  
Intervention Program ◽  
Physical Violence ◽  
Cluster Randomized Trial ◽  
School Students ◽  
Analytical Technique ◽  
Cluster Randomized ◽  
The Impact

Youth violence is of public health and social concern. A South African cluster randomized trial (434 grade 10 students, 16 schools), used the Integrated Model for Behavior Change conceptual framework to implement a 20 module classroom-based intervention program. The study contributes to the literature and used a strong analytical technique since mixed effects linear regression assessed the impact of the intervention on physical violence endpoints and other socioeconomic confounders/factors. The intervention reduced students' experiencing physical violence compared to controls and social pressure for this, yet no differences were found for hitting others. Our results support findings that school programs against violence can reduce students' experience of physical violence, but translation of these findings to reduce the actual hitting of others may need further approaches and/or more time.

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