The objective of the endline surveys in 2016 were to gather household, biomedical, and cognition data in order to evaluate the long-term impact of home supplementation with micronutrient powders (MNP), when combined with seasonal malaria chemoprevention (SMC) and early stimulation, delivered through community preschools and parenting sessions, on the health and cognitive development of children during the first five years of life.
The trial consisted of 3 arms. First, 60 villages with established Early Childhood Development centres (ECD) were randomised to 1 of 2 arms:
1) Children living in villages in the ECD control arm received SMC as part of national health programming and a national parenting intervention delivered by ECD center staff trained and supported by Save the Children, with ALL resident children eligible to participate in the interventions irrespective of enrolment in ECD program (ECD Control group).
2) Children living in villages in the intervention arm also received the SMC and parenting interventions described above, but additionally were eligible to receive home supplementation with micronutrient powders (MNP intervention arm).
3) Second, a third non-randomised arm was recruited comprised of children living in 30 randomly selected villages where there were no ECD centers in place and thus both the parenting interventions and MNPs were absent. These children received SMC only, as part of national health programming (non-ECD comparison arm).
Trial arm and Interventions received:
T1. MNP intervention arm: 30 villages with ECD centre (randomised); MNP-Yes, Parenting-Yes, SMC-Yes
C1. ECD control arm: 30 villages with ECD centre (randomised); MNP-No, Parenting-Yes, SMC-Yes
C2. Non-ECD comparison arm: 30 villages without ECD centre (not randomised); MNP-No, Parenting-No, SMC-Yes
Three cross-sectional endline surveys took place during the period May-August 2016, three years after the original MNP intervention began, and consisted of the following questionnaires and assessments in two age groups of children, 3 year olds and 5 year olds:
i) A household questionnaire was used to collect data from the primary adult caregiver of the child on home environment, exposure to the interventions, and reported practice outcomes of relevance to the parenting intervention.
ii) Biomedical outcomes were measured in children through laboratory and clinical assessment.
iii) A battery of tests were used to assess cognitive performance and school readiness in childen, using a different age-specific test battery for each age group adapted for local language and culture.
Note: Household and cognitive performance data were gathered from participants in all three arms. Biomedical data were only collected from children in the two randomised arms, to evaluate impact of MNP supplementation on anaemia (primary biomedical outcome) in children who received MNPs and those who did not, using a robust study design.