This project aims to reduce child malnutrition in Pakistan by building on local strengths and practical community solutions. The project focuses on children 7-23 months of age. The investigators will aim to recruit young children between 7-15 months of age, giving the youngest children priority over older children so that participants may be followed longitudinally over 6 and 12 months. The project supports participants for six months through learning, practice, and regular follow-up. The work begins with community sensitization events, where local families learn about healthy feeding for young children through group discussions, visuals, and printed materials. These sessions build awareness, encourage community support, and prepare families for the main intervention.
The core of the project is a 28-day behaviour change program. In the first two weeks, mothers and children take part in daily "Hearth" sessions, which are interactive, home-like meetings that teach practical feeding, hygiene, and caregiving skills using local foods. In the next two weeks, mothers apply learned skills at home while being visited regularly by project staff, who provide support and monitor child growth. If children gain at least 400 grams, as recommended by WHO, families graduate to monthly check-ins; if not, families may repeat the 28-day cycle up to three times. This approach targets chronic malnutrition by supporting families in adopting sustainable caregiving practices rather than providing short-term aid.
Educational materials developed with community input support the learning process. Designed with visuals and minimal text, the materials are accessible to both literate and illiterate parents and are distributed widely to encourage shared responsibility for child health.
To measure success, the project uses surveys and growth measurements for both treatment and control groups. Surveys gather information about family demographics, feeding and hygiene behaviours, and health practices, while trained staff measure children's height and weight at regular intervals. The data will help determine whether the intervention improves children's nutritional status and caregiving practices.
Ultimately, the project seeks to empower families and communities to use local resources and knowledge to support healthier child growth. The project combines community engagement, hands-on learning, and scientific evaluation to promote lasting change in how families feed, nurture, and care for young children.
Priority will be given to younger children, aged 7-11 months, followed by 12-15 months to allow completion of the intervention and follow-up visits before the child turns 24 months of age, as complementary feeding refers to feeding practices between the ages of 6-24 months.
Moderate malnutrition, defined by: Weight-for-age Z-score between -2 and -3 standard deviations.
They meet the classification of very poor or poor (based on community-defined wealth stratification).
Have access to clean water and sanitation.
Children who are Severely malnourished, mildly underweight or of normal weight.
Children with Physical disabilities: difficulty in seeing, hearing, picking up small objects with his/her hand.
Malabsorption
Chronic Kidney Disease
Parallel
28-day Behavioural Change Program
BehavioralThe study's intervention includes a 28-day program with group sessions in a home-like setting (Hearth) where mothers of moderately malnourished children and family members learn practical ways to prepare nutritious meals and improve caregiving practices. Each cycle has two parts: Group Hearth Sessions (2 weeks): About 15 mother-child pairs attend sessions. Sessions will focus on knowledge about complementary feeding, active feeding, hygiene, caregiving, and health-seeking behaviours. Mothers will take part in cooking and caring demonstrations, rotating through roles to build hands-on skills. Home Practice (2 weeks): Field staff visit each home three times per week to reinforce new behaviours, provide guidance, and monitor progress. Mothers contribute small items such as eggs, rice, or utensils to reflect real-life conditions, while the project provides pots, utensils, and most of the food. This shared approach promotes engagement and helps sustain improved practices at home.
Weight
Index Child's weight will be measured in Kilogram(Kg) and will be used to assess the Index child's nutritional status.
Weight-for-age Z-score
Nutritional status of Index child will classify as (1) severely underweight, (2) moderate underweight, (3) mild underweight, (4) well-nourished or normal weight using weight-for-age Z-score as below. Severely underweight if weight-for-age Z-score \<-3 SD of the median. Moderate underweight if weight-for-age Z-score between -2 SD and -3 SD. Mild underweight if weight-for-age Z-score between -1 SD and -2 SD. Normal weight if weight-for-age Z-score between -1 SD and +1 SD.
Length
Index Child's length will be measured in centimeters(cm) and will be used to assess the Index child's nutritional status and Height-for-Age Z-score.
Height-for-age Z-score
Length measurement will be used to classify Index child as (1) severely stunted, (2) moderately stunted, (3) mildly stunted, (4) Normal length using length/height-for-age Z-score. Severe stunting if length/height-for-age Z-score \<-3 SD of the median. Moderate stunting if length/height-for-age Z-score between -2 SD and -3 SD. Mild stunting if length/height-for-age Z-score between -1 SD and -2 SD. Normal length if length/height-for-age Z-score between -1 SD and +1 SD.
Mid-upper arm circumference (MUAC)
MUAC measurement for Index child will be assessed to classify (1) Green \>12.5 cm, (2) Yellow 11.5-12.5 cm and (3) Red \<11.5 cm.
Weight-for-Height Z-Score
This measurement assesses how the child's weight compares to the median weight of children their same age and height. Sign of wasting classify as (1) severe wasting, (2) moderate wasting, (3) marginal wasting, (4) well-nourished
Click on the lead sponsor to view all of their trials.
University of British Columbia
Lead sponsor
Canadian Institutes of Health Research (CIHR)
Collaborator
Aga Khan University Hospital, Pakistan
Collaborator
