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

每年有220万儿童死于营养不良。由于营养不良对他们的健康和智力的影响，更多的人的生命机会受到限制。已经尝试了不同的方案来解决儿童营养不良的问题。这些措施包括直接分发食物；向儿童提供微量营养素(如维生素和锌)；雇用社区工作人员提供营养建议；以及保护儿童免受营养不良后果的健康干预(如麻疹免疫接种)。世界卫生组织(WHO)等机构的研究表明，这些策略可以让儿童获得更好的营养。然而，当这些方法被大规模使用时(例如整个国家)，它们有时无法接触到最需要帮助的人(那些生活在极端贫困中的人)。为了帮助最多的儿童，我们必须选择成本效益高、可长期维持的办法。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与贫困作斗争的经验。我们的社区工作人员鼓励印度北部贫困小村庄或“托拉”的人们成立自助小组(SHGs)。大多数SHG都是由女性组成的。他们被要求定期存一点钱，最初是每周2.5卢比(3便士)。如果他们定期储蓄，他们的储蓄就有权获得贷款。这些贷款的起点很小--50卢比(50便士)。该群体中的妇女可以在3个月后获得500卢比(5 GB)的外部贷款，在6个月后(如果信用良好)获得3000卢比(30 GB)的外部贷款。贷款可用于紧急情况(如医疗费用)；允许妇女获得现有的政府支助计划(如前往受补贴的食品店的钱)；或投资于牲畜或农业设备。使用这些贷款帮助妇女避开当地的放债人(他们收取的利息要高得多)，并避免紧急出售她们的财产(以极低的价格)。我们称这个项目为Rojiroti(翻译为“生计”)。我们想看看是否可以通过一种名为“随机分组对照试验”的测试来测试Rojiroti是否能改善儿童的健康状况。我们还没有设计这样一项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。我们将从检查同意、称重和测量儿童、准确收集数据和跟踪试验参与者等事情的可行性开始。我们将进行这项试验的一个小版本(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，衡量Rojiroti有效性的一个关键指标将是根据身高校正后的儿童体重。这被称为身高体重Z分数(WHZ)。然而，我们还将记录其他营养指标。我们需要初步数据来计算出我们需要多少托拉才能进行最终试验，以测试罗吉罗蒂对儿童营养的影响(如果有的话)。在我们的初步研究中，一半的Tolas将立即获得Rojiroti，另一半将在18个月后获得。哪一组人立即得到罗吉罗蒂将随机决定。我们将在开始时称重和测量儿童，并在18个月后再次测量。我们将对这两组人进行比较，看看罗吉罗蒂是否对儿童的营养有所不同。我们不期望能够在我们的初步研究中显示出不同之处。然而，一旦我们进行了初步研究，我们就会知道需要多少钱才能进行全面的试验，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，以及审判将花费多少钱。然后，我们可以提出资金申请，其中将包含所有必要的细节。

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.