<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03824756</url>
  </required_header>
  <id_info>
    <org_study_id>PR-17123</org_study_id>
    <nct_id>NCT03824756</nct_id>
  </id_info>
  <brief_title>Assessing the Effectiveness of Strengthening the Growth Monitoring and Promotional Activities in Rural Bangladesh</brief_title>
  <acronym>GMP</acronym>
  <official_title>Assessing the Effectiveness of Strengthening the Growth Monitoring and Promotional Activities in Improving the Nutritional Status of Children Under 2 Years of Age in Rural Bangladesh</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>International Centre for Diarrhoeal Disease Research, Bangladesh</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>United States Agency for International Development (USAID)</agency>
      <agency_class>U.S. Fed</agency_class>
    </collaborator>
  </sponsors>
  <source>International Centre for Diarrhoeal Disease Research, Bangladesh</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Background: To tackle the high burden of undernutrition, the government of Bangladesh has&#xD;
      identified growth monitoring and promotion (GMP) as a priority activity in the National&#xD;
      Nutrition Services operational plan. Till date, no evidence are available from Bangladeshi&#xD;
      studies to identify the effectiveness of GMP in improving the nutritional status of&#xD;
      Bangladeshi children under 2 years of age. During 2013-14, two Bangladeshi studies looking at&#xD;
      implementation issues of GMP at Community Clinic level and assessing the quality of nutrition&#xD;
      services at primary health care facilities. The studies identified that lack of coordination,&#xD;
      inadequate training, supervision, and logistic supplies as challenges to GMP implementation.&#xD;
      Currently, GMP, (primarily sick child GMP) is being implemented through community clinics,&#xD;
      supported by non-governmental organizations (NGOs) or other programs funded by donors.&#xD;
      Besides, GMP is also taking place in areas where there are no NGO or donor support&#xD;
      activities. However, the quality of nutrition data related to GMP is believed to be&#xD;
      unsatisfactory. Hence, it is important to assess the effectiveness of GMP on the growth of&#xD;
      under 2-year-old children.&#xD;
&#xD;
      Hypothesis: GMP services could improve the growth of children under 2 years of age by 20&#xD;
      percent in the intervention group compared to the control group&#xD;
&#xD;
      Objectives:To examine the effectiveness of GMP in improving nutritional status of children&#xD;
      under 2 years of age&#xD;
&#xD;
      Methods:&#xD;
&#xD;
      Study design: Quasi-experimental study using mixed methods Study duration: 24 months Study&#xD;
      setting: The study will be conducted in six sub-districts of rural Bangladesh where GMP is&#xD;
      operational at the community clinic level. However, those areas will be excluded if there is&#xD;
      any ongoing community or household level intervention on nutrition counseling being&#xD;
      implemented by an NGO. For smooth implementation of GMP, refresher training on nutrition to&#xD;
      health service providers will be provided by the study team.&#xD;
&#xD;
      Study participants: children under 2 years of age, mother's/caregiver's of children &lt;2 and&#xD;
      service providers.&#xD;
&#xD;
      Intervention group: children under 2 years of age who are exposed to GMP services at&#xD;
      community clinics where an NGO funded program is supporting GMP implementation Control group:&#xD;
      children under 2 years of age, at community clinics where GMP is not operational&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Introduction and objective:&#xD;
&#xD;
      Bangladesh has partly achieved the millennium development goal targets for nutrition and is&#xD;
      committed to achieving the Sustainable development goals targets. Between 1997 and 2014,&#xD;
      childhood stunting reduced from 60% to 36% nationally, and wasting has declined from 21% to&#xD;
      14%. However, 6.4 million children remain stunted, leaving them unable to develop to their&#xD;
      full physical and mental potential. To tackle the high burden of under-nutrition, the&#xD;
      government of Bangladesh has identified growth monitoring and promotion (GMP) as a priority&#xD;
      activity in the National Nutrition Services operational plan. GMP is to be implemented from&#xD;
      all primary health care facilities of the government health system. Growth Monitoring and&#xD;
      Promotion (GMP) is a preventive activity comprised of growth monitoring linked with promotion&#xD;
      (usually counseling) that increases awareness about child growth and improves caring&#xD;
      practices. Ideally, in GMP, the weight of children usually under 2 years of age is measured&#xD;
      periodically (for example, on a monthly or bi-monthly basis). The measurement can start at&#xD;
      birth, accurately recorded on a growth chart, interpreted and explained to the caregivers.&#xD;
      Additionally, the health workers give information through counseling, facilitating&#xD;
      communication, and interacting with mothers in a way that aims to generate adequate maternal&#xD;
      action to promote child growth. Recent systematic reviews question the effectiveness and&#xD;
      relevance of GMP programs in general. Currently, GMP, which is primarily focused on sick&#xD;
      child GMP is being implemented through community clinics (CCs), supported by NGOs or other&#xD;
      programs funded by donors. Besides, GMP is also taking place in areas where there are no&#xD;
      non-governmental organization (NGO) or donor support activities. However, the quality of&#xD;
      nutrition data related to GMP is believed to be unsatisfactory. On this backdrop, it is&#xD;
      important to assess the GMP implementation and its effect on the growth of under 2-year-old&#xD;
      children. Hence, this study will offer a useful opportunity to examine the effectiveness of&#xD;
      strengthening the GMP activities in improving growth and infant and young child feeding&#xD;
      (IYCF) practices among children under 2 years of age in rural Bangladesh.&#xD;
&#xD;
      Selection of study site:&#xD;
&#xD;
      From the discussion and list of sub-districts shared by the NGO program, the investigators&#xD;
      have selected 3 sub-districts where the program will be implemented from January 2018. The&#xD;
      investigators have selected these 3 sub-districts based on (a) time of implementation of the&#xD;
      program which matches with the project timeline; (b) available staff and logistics support by&#xD;
      the NGO program in these sub-districts; and (c) large number of Community Clinics in these&#xD;
      sub-districts to satisfy the required number of study participants and their caregivers.&#xD;
      Additionally, the investigators have also selected 3 sub-districts as control keeping an&#xD;
      adequate buffer zone to avoid intervention spill-over effect. The investigators will select&#xD;
      30 community clinics from these sub-districts through a community scoring system to have the&#xD;
      maximum impact of the program.&#xD;
&#xD;
      Selection of study participants: The community clinics (CCs) and its catchment area will be&#xD;
      considered as clusters. From the list of community clinics, required numbers of clusters will&#xD;
      be randomly selected through a proportionate sampling. From the randomly selected CCs, the&#xD;
      required number of study participants will be enrolled after conducting household listing.&#xD;
&#xD;
      Data collection procedures: The children will be enrolled from the catchment area of&#xD;
      community clinics and be followed up for 12 months. During the follow-up period, the children&#xD;
      will be visited periodically to assess their exposure to GMP service and also their feeding&#xD;
      practice. Anthropometric measurements will be taken at baseline and then tri-monthly till the&#xD;
      end of the 12 months follow-up period. Mother's knowledge and attitude about IYCF issues will&#xD;
      be assessed at baseline and at an endpoint survey. Service provider's skills and perception&#xD;
      about GMP will be assessed at baseline and at end-line. Quality of GMP implementation will be&#xD;
      at baseline and periodically during the follow-up period.&#xD;
&#xD;
      Data collection tools: Household surveys, key informant interviews (KII), and observation.&#xD;
&#xD;
      Data analysis The survey data will be analyzed using STATA software (version 13). The summary&#xD;
      statistics would be expressed as means with standard deviations, medians or percentages, with&#xD;
      95% confidence intervals (CI) where appropriate. To assess differences in mean among the&#xD;
      factories, ANOVA and for categorical outcomes, chi-square statistical comparisons of&#xD;
      proportions with 95% confidence intervals, will be calculated. A difference-of-difference&#xD;
      (DID) analysis of quantitative outcome data will be done. To identify significant predictors&#xD;
      associated with the main outcome indicators, bi-variate and multiple regression analyses will&#xD;
      be employed.&#xD;
&#xD;
      Thematic analysis will be followed for qualitative information collected through&#xD;
      participant's caregiver interview, key informant interview, and observation. Following&#xD;
      preparation of the transcript, responses will be coded according to themes (a priori),&#xD;
      sub-themes and emergent issues, if any. Triangulation of data derived from different methods&#xD;
      will be carried out to validate qualitative information.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Not yet recruiting</overall_status>
  <start_date type="Anticipated">July 1, 2022</start_date>
  <completion_date type="Anticipated">December 30, 2022</completion_date>
  <primary_completion_date type="Anticipated">December 30, 2022</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Non-Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Health Services Research</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in length of the children under 2 years of age</measure>
    <time_frame>12 months</time_frame>
    <description>Children who are aged between 6-12 months, their length in centimeter will be measured at baseline and then 3 monthly till end-line using a standard length board. The length for age z-score will be calculated by using a software developed by World Health Organization. The changes in length for age z-score will be detected through comparing the measurements over time by using difference-in-difference method.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Change in weight of the children under 2 years of age</measure>
    <time_frame>12 months</time_frame>
    <description>Children who are aged between 6-12 months, their weight in kilograms will be measured at baseline and then 3 monthly till end-line using a standard weighing scale. The weight for age z-score will be calculated by using a software developed by World Health Organization. The changes in weight for age z-score will be detected through comparing the measurements over time by using difference-in-difference method.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in mother's knowledge and attitude on infant and young child feeding (IYCF) practices measured by a standard semi-structured questionnaire</measure>
    <time_frame>12 months</time_frame>
    <description>The change in IYCF practice will be reported in percentages through baseline and end-line differences through following indicators (either combined or separately):&#xD;
Early initiation of breastfeeding&#xD;
Introduction of solid, semi-solid or soft foods&#xD;
Minimum dietary diversity&#xD;
Minimum meal frequency&#xD;
Minimum acceptable diet: It summed the results of Minimum dietary diversity and Minimum meal frequency.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in service provider's skill and perception on GMP</measure>
    <time_frame>12 months</time_frame>
    <description>The community clinic service provider's skill and perception on GMP will be measured by using observation checklist and key informant interviews at baseline and end-line. The responses gathered from this 2 time points will be compared at the end of the study.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">2000</enrollment>
  <condition>Nutritional Status</condition>
  <arm_group>
    <arm_group_label>NGO supported GMP program</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Intervention: NGO supported GMP program Site: Community clinic Duration: 12 months Study participants: 6-12 months aged children living within community clinic catchment area</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Non-supported GMP program</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Comparison: Non-supported GMP program Site: Community clinic Duration: 12 months Study participants: 6-12 months aged children living within community clinic catchment area</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>NGO supported GMP program</intervention_name>
    <description>An International NGO has signed a contract with Government to support in implementing the growth Monitoring and Promotion (GMP) program. This program will be implemented at Community clinics. It will ensure the sustainability of community clinics in the selected areas through capacity building and follow up with community groups, community support groups, and Government Health and Family Planning service providers.</description>
    <arm_group_label>NGO supported GMP program</arm_group_label>
    <other_name>Intervention arm</other_name>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Non-supported GMP program</intervention_name>
    <description>This is control arm of the study. In this arm, there will be Government's usual GMP program implemented at community clinics without any NGO support.</description>
    <arm_group_label>Non-supported GMP program</arm_group_label>
    <other_name>Control arm</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          1. Children aged between 6-12 months living in community clinic catchment area&#xD;
&#xD;
          2. Free from any acute or chronic illness(es)&#xD;
&#xD;
          3. Not a known case of a congenital anomaly or chromosomal abnormality&#xD;
&#xD;
          4. Not severely stunted (length-for-age Z score, LAZ &lt;-3) or wasted (weight-for-length Z&#xD;
             score, WLZ &lt;-3) or underweight (weight-for-age Z score, WAZ &lt;-3)&#xD;
&#xD;
          5. Not enrolled in any other intervention program&#xD;
&#xD;
          6. Caregiver report to have no plans to move out of the catchment area for at least 6&#xD;
             months following enrolment in the study&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
        Children's parents who will decline consent will not be enrolled in the study&#xD;
&#xD;
        -&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>6 Months</minimum_age>
    <maximum_age>12 Months</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Muttaquina Hossain, MPH</last_name>
    <role>Principal Investigator</role>
    <affiliation>Assistant Scientist</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Muttaquina Hossain, MPH</last_name>
    <phone>02-01923758956</phone>
    <email>muttaquina@icddrb.org</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Tahmeed Ahmed, PhD</last_name>
    <phone>02-01713044799</phone>
    <email>tahmeed@icddrb.org</email>
  </overall_contact_backup>
  <verification_date>February 2022</verification_date>
  <study_first_submitted>January 17, 2019</study_first_submitted>
  <study_first_submitted_qc>January 29, 2019</study_first_submitted_qc>
  <study_first_posted type="Actual">January 31, 2019</study_first_posted>
  <last_update_submitted>March 30, 2022</last_update_submitted>
  <last_update_submitted_qc>March 30, 2022</last_update_submitted_qc>
  <last_update_posted type="Actual">March 31, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Growth monitoring and promotion</keyword>
  <keyword>child growth</keyword>
  <keyword>Infant and young child feeding practices</keyword>
  <keyword>program</keyword>
  <keyword>Bangladesh</keyword>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
    <ipd_description>The privacy, anonymity, and confidentiality of data/information identifying the study participants will be strictly maintained. Personal identifications taken during the survey will be kept under lock and key. None other than the study personnel will have access to information on personal identification and other sensitive information.</ipd_description>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03824756
org study id: PR-17123
nct id: NCT03824756
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Background: To tackle the high burden of undernutrition, the government of Bangladesh has
      identified growth monitoring and promotion (GMP) as a priority activity in the National
      Nutrition Services operational plan. Till date, no evidence are available from Bangladeshi
      studies to identify the effectiveness of GMP in improving the nutritional status of
      Bangladeshi children under 2 years of age. During 2013-14, two Bangladeshi studies looking at
      implementation issues of GMP at Community Clinic level and assessing the quality of nutrition
      services at primary health care facilities. The studies identified that lack of coordination,
      inadequate training, supervision, and logistic supplies as challenges to GMP implementation.
      Currently, GMP, (primarily sick child GMP) is being implemented through community clinics,
      supported by non-governmental organizations (NGOs) or other programs funded by donors.
      Besides, GMP is also taking place in areas where there are no NGO or donor support
      activities. However, the quality of nutrition data related to GMP is believed to be
      unsatisfactory. Hence, it is important to assess the effectiveness of GMP on the growth of
      under 2-year-old children.

      Hypothesis: GMP services could improve the growth of children under 2 years of age by 20
      percent in the intervention group compared to the control group

      Objectives:To examine the effectiveness of GMP in improving nutritional status of children
      under 2 years of age

      Methods:

      Study design: Quasi-experimental study using mixed methods Study duration: 24 months Study
      setting: The study will be conducted in six sub-districts of rural Bangladesh where GMP is
      operational at the community clinic level. However, those areas will be excluded if there is
      any ongoing community or household level intervention on nutrition counseling being
      implemented by an NGO. For smooth implementation of GMP, refresher training on nutrition to
      health service providers will be provided by the study team.

      Study participants: children under 2 years of age, mother's/caregiver's of children <2 and
      service providers.

      Intervention group: children under 2 years of age who are exposed to GMP services at
      community clinics where an NGO funded program is supporting GMP implementation Control group:
      children under 2 years of age, at community clinics where GMP is not operational
Introduction and objective:

      Bangladesh has partly achieved the millennium development goal targets for nutrition and is
      committed to achieving the Sustainable development goals targets. Between 1997 and 2014,
      childhood stunting reduced from 60% to 36% nationally, and wasting has declined from 21% to
      14%. However, 6.4 million children remain stunted, leaving them unable to develop to their
      full physical and mental potential. To tackle the high burden of under-nutrition, the
      government of Bangladesh has identified growth monitoring and promotion (GMP) as a priority
      activity in the National Nutrition Services operational plan. GMP is to be implemented from
      all primary health care facilities of the government health system. Growth Monitoring and
      Promotion (GMP) is a preventive activity comprised of growth monitoring linked with promotion
      (usually counseling) that increases awareness about child growth and improves caring
      practices. Ideally, in GMP, the weight of children usually under 2 years of age is measured
      periodically (for example, on a monthly or bi-monthly basis). The measurement can start at
      birth, accurately recorded on a growth chart, interpreted and explained to the caregivers.
      Additionally, the health workers give information through counseling, facilitating
      communication, and interacting with mothers in a way that aims to generate adequate maternal
      action to promote child growth. Recent systematic reviews question the effectiveness and
      relevance of GMP programs in general. Currently, GMP, which is primarily focused on sick
      child GMP is being implemented through community clinics (CCs), supported by NGOs or other
      programs funded by donors. Besides, GMP is also taking place in areas where there are no
      non-governmental organization (NGO) or donor support activities. However, the quality of
      nutrition data related to GMP is believed to be unsatisfactory. On this backdrop, it is
      important to assess the GMP implementation and its effect on the growth of under 2-year-old
      children. Hence, this study will offer a useful opportunity to examine the effectiveness of
      strengthening the GMP activities in improving growth and infant and young child feeding
      (IYCF) practices among children under 2 years of age in rural Bangladesh.

      Selection of study site:

      From the discussion and list of sub-districts shared by the NGO program, the investigators
      have selected 3 sub-districts where the program will be implemented from January 2018. The
      investigators have selected these 3 sub-districts based on (a) time of implementation of the
      program which matches with the project timeline; (b) available staff and logistics support by
      the NGO program in these sub-districts; and (c) large number of Community Clinics in these
      sub-districts to satisfy the required number of study participants and their caregivers.
      Additionally, the investigators have also selected 3 sub-districts as control keeping an
      adequate buffer zone to avoid intervention spill-over effect. The investigators will select
      30 community clinics from these sub-districts through a community scoring system to have the
      maximum impact of the program.

      Selection of study participants: The community clinics (CCs) and its catchment area will be
      considered as clusters. From the list of community clinics, required numbers of clusters will
      be randomly selected through a proportionate sampling. From the randomly selected CCs, the
      required number of study participants will be enrolled after conducting household listing.

      Data collection procedures: The children will be enrolled from the catchment area of
      community clinics and be followed up for 12 months. During the follow-up period, the children
      will be visited periodically to assess their exposure to GMP service and also their feeding
      practice. Anthropometric measurements will be taken at baseline and then tri-monthly till the
      end of the 12 months follow-up period. Mother's knowledge and attitude about IYCF issues will
      be assessed at baseline and at an endpoint survey. Service provider's skills and perception
      about GMP will be assessed at baseline and at end-line. Quality of GMP implementation will be
      at baseline and periodically during the follow-up period.

      Data collection tools: Household surveys, key informant interviews (KII), and observation.

      Data analysis The survey data will be analyzed using STATA software (version 13). The summary
      statistics would be expressed as means with standard deviations, medians or percentages, with
      95% confidence intervals (CI) where appropriate. To assess differences in mean among the
      factories, ANOVA and for categorical outcomes, chi-square statistical comparisons of
      proportions with 95% confidence intervals, will be calculated. A difference-of-difference
      (DID) analysis of quantitative outcome data will be done. To identify significant predictors
      associated with the main outcome indicators, bi-variate and multiple regression analyses will
      be employed.

      Thematic analysis will be followed for qualitative information collected through
      participant's caregiver interview, key informant interview, and observation. Following
      preparation of the transcript, responses will be coded according to themes (a priori),
      sub-themes and emergent issues, if any. Triangulation of data derived from different methods
      will be carried out to validate qualitative information.
allocation: Non-Randomized
intervention model: Parallel Assignment
primary purpose: Health Services Research
masking: None (Open Label)
measure: Change in length of the children under 2 years of age
time frame: 12 months
description: Children who are aged between 6-12 months, their length in centimeter will be measured at baseline and then 3 monthly till end-line using a standard length board. The length for age z-score will be calculated by using a software developed by World Health Organization. The changes in length for age z-score will be detected through comparing the measurements over time by using difference-in-difference method.
measure: Change in weight of the children under 2 years of age
time frame: 12 months
description: Children who are aged between 6-12 months, their weight in kilograms will be measured at baseline and then 3 monthly till end-line using a standard weighing scale. The weight for age z-score will be calculated by using a software developed by World Health Organization. The changes in weight for age z-score will be detected through comparing the measurements over time by using difference-in-difference method.
measure: Change in mother's knowledge and attitude on infant and young child feeding (IYCF) practices measured by a standard semi-structured questionnaire
time frame: 12 months
description: The change in IYCF practice will be reported in percentages through baseline and end-line differences through following indicators (either combined or separately):
Early initiation of breastfeeding
Introduction of solid, semi-solid or soft foods
Minimum dietary diversity
Minimum meal frequency
Minimum acceptable diet: It summed the results of Minimum dietary diversity and Minimum meal frequency.
measure: Changes in service provider's skill and perception on GMP
time frame: 12 months
description: The community clinic service provider's skill and perception on GMP will be measured by using observation checklist and key informant interviews at baseline and end-line. The responses gathered from this 2 time points will be compared at the end of the study.
arm group label: NGO supported GMP program
arm group type: Experimental
description: Intervention: NGO supported GMP program Site: Community clinic Duration: 12 months Study participants: 6-12 months aged children living within community clinic catchment area
arm group label: Non-supported GMP program
arm group type: Active Comparator
description: Comparison: Non-supported GMP program Site: Community clinic Duration: 12 months Study participants: 6-12 months aged children living within community clinic catchment area
intervention type: Other
intervention name: NGO supported GMP program
description: An International NGO has signed a contract with Government to support in implementing the growth Monitoring and Promotion (GMP) program. This program will be implemented at Community clinics. It will ensure the sustainability of community clinics in the selected areas through capacity building and follow up with community groups, community support groups, and Government Health and Family Planning service providers.
arm group label: NGO supported GMP program
other name: Intervention arm
intervention type: Other
intervention name: Non-supported GMP program
description: This is control arm of the study. In this arm, there will be Government's usual GMP program implemented at community clinics without any NGO support.
arm group label: Non-supported GMP program
other name: Control arm
criteria: 
gender: All
minimum age: 6 Months
maximum age: 12 Months
healthy volunteers: Accepts Healthy Volunteers
last name: Muttaquina Hossain, MPH
role: Principal Investigator
affiliation: Assistant Scientist
last name: Muttaquina Hossain, MPH
phone: 02-01923758956
email: muttaquina@icddrb.org
last name: Tahmeed Ahmed, PhD
phone: 02-01713044799
email: tahmeed@icddrb.org
responsible party type: Sponsor
sharing ipd: No
ipd description: The privacy, anonymity, and confidentiality of data/information identifying the study participants will be strictly maintained. Personal identifications taken during the survey will be kept under lock and key. None other than the study personnel will have access to information on personal identification and other sensitive information.