A feasibility and pilot study of the effects of Rojiroti microfinance on the health and nutrition of children under five in Bihar, northern India

Rojiroti 小额信贷对印度北部比哈尔邦五岁以下儿童健康和营养影响的可行性和试点研究

• 批准号: MR/M021904/1
• 负责人: Alan Smyth
• 金额: $ 15.31万
• 依托单位: University of Nottingham
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM021904%2F1
• 关键词: feasibility; pilot; study; effects; Rojiroti

Every year, 2.2 million children die of malnutrition. Many more have their life chances restricted because of the effects of malnutrition on their health and intellect. Different programmes have been tried to combat malnutrition in children. These include distributing food directly; giving children micronutrients (eg vitamins and zinc); employing community workers to give nutritional advice; and health interventions which protect children against the consequences of malnutrition (eg immunisation against measles). Research by bodies such as the World Health Organisation (WHO) has shown that these strategies can lead to better nourished children. However, when these approaches are used in a large scale (eg a whole country) they sometimes fail to reach those most in need (those living in extreme poverty). To help the greatest number of children, we must choose approaches which are cost effective and which can be sustained in the long term. We are a group of community workers, scientists, economists and doctors. Our partners are the Centre for Promoting Sustainable Livelihood (CPSL) - which is a non-governmental organisation in India: a UK charity (Rojiroti UK); Patna Medical College India; and two UK academic partners (the University of Nottingham and the Liverpool School of Tropical Medicine). Our team have experience of helping very poor people in rural areas of India to fight poverty. Our community workers encourage people in poor hamlets or "tolas" in northern India to form self help groups (SHGs). Most SHGs are formed by women. They are asked to save a little money regularly, initially Rs2.5 (3 pence) per week. If they save regularly, their savings entitle them to a loan. These loans start small - Rs50 (50 pence). Women in the group can receive external loans (from CPSL) of Rs500 (£5) after 3 months and Rs3,000 (£30) after 6 months (if credit is good). Loans may be used for emergencies (eg medical expenses); to allow women access existing government support schemes (eg money to travel to subsidised food shops); or to invest in livestock or agricultural equipment. Using these loans helps women avoid local money lenders (who charge much higher interest) and avoid emergency sales of their property (at knock down prices). We call this programme Rojiroti (which translates as "Livelihood"). We want to see if we can test whether Rojiroti improves children's health, using a test called a "cluster randomised controlled trial". We don't yet have all the information we need to design such a trial so we will first do a feasibility and pilot study. We will start by checking the feasibility of things like consent, weighing and measuring children, collecting data accurately and keeping track of participants in the trial. We will run a small version of the trial (called a pilot study) so that we have some preliminary data on children's nutrition. We think a key measure of the effectiveness of Rojiroti will be the children's weight corrected for height. This is called the weight for height Z score (WHZ). However, we will also record other measures of nutrition. We need preliminary data to work out how many tolas we will need for the definitive trial to test the effect (if any) of Rojiroti on children's nutrition. In our pilot study, half the tolas will get Rojiroti immediately and half will get it after 18 months. Which group gets Rojiroti immediately will be decided at random. We will weigh and measure children at the beginning and again after 18 months. We will compare the two groups to see if Rojiroti makes a difference to children's nutrition. We do not expect to be able to show a difference in our pilot study. However, once we have done the pilot study, we will know how many tolas we would need for a full trial which would answer the question. This means we can work out how many staff we will need and what the trial will cost. We can then make a funding application which will have all the necessary details.

每年有220万儿童死于营养不良。更多的人由于营养不良对其健康和智力的影响，生活机会受到限制。为消除儿童营养不良现象，已尝试了不同的方案。这些措施包括直接分发食物;给儿童微量营养素（如维生素和锌）;雇用社区工作者提供营养咨询;以及保护儿童免受营养不良后果的健康干预措施（如麻疹免疫接种）。世界卫生组织（WHO）等机构的研究表明，这些战略可以改善儿童的营养状况。然而，当这些方法被大规模使用时（如整个国家），它们有时无法达到最需要的人（生活在极端贫困中的人）。为了帮助尽可能多的儿童，我们必须选择具有成本效益和可以长期持续的方法。我们是一群社区工作者、科学家、经济学家和医生。我们的合作伙伴是促进可持续生计中心（CPSL）-这是印度的一个非政府组织：英国慈善机构（Rojiroti UK）;印度巴特那医学院;以及两个英国学术合作伙伴（诺丁汉大学和利物浦热带医学院）。我们的团队有帮助印度农村地区非常贫困的人消除贫困的经验。我们的社区工作人员鼓励印度北方贫穷村庄或“tolas”的人们组成自助团体。大多数自助团体由妇女组成。他们被要求定期存一点钱，最初每周2.5卢比（3便士）。如果他们定期储蓄，他们的储蓄使他们有权获得贷款。这些贷款从50卢比（50便士）开始。该团体的妇女可以在3个月后获得500卢比（5英镑）的外部贷款（来自CPSL），在6个月后获得3 000卢比（30英镑）的贷款（如果信用良好）。贷款可用于紧急情况（例如医疗费用）;允许妇女获得现有的政府支持计划（例如前往补贴食品店的资金）;或投资于牲畜或农业设备。使用这些贷款可以帮助妇女避开当地的放债人（他们收取的利息要高得多），避免紧急出售其财产（以低价）。我们把这个方案称为Rojiroti（翻译过来就是“生计”）。我们想看看我们是否可以测试Rojiroti是否改善儿童的健康，使用一种称为“集群随机对照试验”的测试。我们还没有设计这样一个试验所需的所有信息，所以我们将首先进行可行性和试点研究。我们将首先检查同意、称量和测量儿童体重、准确收集数据以及跟踪试验参与者等事项的可行性。我们将进行一个小规模的试验（称为试点研究），这样我们就有了一些关于儿童营养的初步数据。我们认为Rojiroti有效性的一个关键衡量标准将是儿童的身高校正体重。这被称为身高体重Z评分（WHZ）。然而，我们也将记录其他营养措施。我们需要初步的数据来计算出我们需要多少tola来进行最终的试验，以测试Rojiroti对儿童营养的影响（如果有的话）。在我们的试点研究中，一半的tolas将立即获得Rojiroti，另一半将在18个月后获得。哪一组立即获得Rojiroti将随机决定。我们将在开始时和18个月后再次对儿童进行称重和测量。我们将比较两组，看看Rojiroti是否对儿童的营养有影响。我们并不期望能够在我们的试点研究中显示出差异。然而，一旦我们完成了试点研究，我们将知道我们需要多少tola才能回答这个问题。这意味着我们可以计算出我们需要多少工作人员以及试验的费用。然后，我们可以提出一个资金申请，其中将有所有必要的细节。

项目成果

Response to Journal Club: Cluster Randomized Trial Evaluating Impact of a Community-based Microfinance Scheme on Childhood Nutritional Status: Evidence-based Medicine Viewpoint

对期刊俱乐部的回应：评估基于社区的小额信贷计划对儿童营养状况影响的整群随机试验：循证医学观点

• 发表时间: 2020
• 期刊: Indian Pediatrics
• 影响因子: 2.3
• 作者: Shalini Ojha;A. Smyth;J. Mathew
• 通讯作者: J. Mathew

Daily Bread: Women's Self-Help Microfinance and the Social Meanings of Money

每日面包：女性自助小额信贷和金钱的社会意义

• DOI: 10.1177/13607804211058745
• 发表时间: 2022
• 期刊: Sociological Research Online
• 影响因子: 1.6
• 作者: Bott E