A Community Health Worker-Based Intervention on Anthropometric Outcomes of Children Aged 3 to 21 Months in Urban Pakistan, 2019-2021.

Abstract

<b>Objectives.</b> To evaluate the impact of a community health worker-based "in-home growth monitoring with counseling" (IHGMC) intervention on anthropometric outcomes in Pakistan, where 38% of children younger than 5 years are stunted. <b>Methods.</b> We used an individual, single-blind, step-wedge randomized controlled trial and a pure control group recruited at endline. We based the analysis on an intention-to-treat estimation using the coarsened exact matching (CEM) method for sample selection among treatments and the control. We conducted the baseline in July 2019 and completed endline in September-October 2021. We recruited 1639 households (treated: 1188; control: 451) with children aged 3 to 21 months who were residing in an urban informal settlement area. The CEM sample used for analysis numbered 1046 (treated: 636; control: 410). The intervention continued for 6 months. <b>Results.</b> Compared with the control group, the height-for-age <i>z</i>-score in the IHGMC group increased by 0.58 SD (95% confidence interval [CI] = 0.33, 0.83; <i>P</i> = .001) and the weight-for-age <i>z</i>-score by 0.43 SD (95% CI = 0.20, 0.67; <i>P</i> < .01), measured at endline. <b>Conclusions.</b> IHGMC substantially improved child anthropometric outcomes in disadvantaged localities, and this impact persisted during the COVID-19 pandemic. <b>Trial Registration.</b> AER-RCT registry (AEARCTR-0003248). (<i>Am J Public Health</i>. 2023;113(1):105-114. https://doi.org/10.2105/AJPH.2022.307111).