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

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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.