Healthy future: a community health worker program to improve maternal, newborn and child health in rural China

INTERVENTION: Control group: no intervention Treatment group: Healthy Future program for 12 months, from May 2019 to May 2020 ‐ Caregivers in the treatment group will receive a caregiver education intervention that aims to improve early childhood nutrition and health, and maternal well‐being through monthly home visits by trained community health workers. The intervention ranges in coverage from the second trimester of pregnancy to when the child turns 18 months of age, depending on child age at enrolment. ‐ Half of the treatment villages will receive an encouragement condition where both primary and secondary caregivers of young children are encouraged to participate in the home visit activities. By comparison, the standard condition will target the primary caregivers. ‐ In communities that receive free micronutrient supplements for young children as part of a government program, the community health workers will assist with delivering these micronutrient packages to recipient households. Following the baseline survey, villages will be randomly allocated to each of the two main study arms. Within the treatment arm, half of the villages will be randomized to standard or encouragement treatment conditions. Randomization will be stratified at the county level. A canvass survey was conducted in two government‐designated poverty counties in Shaanxi Province between November 2018 and March 2019 to yield a list of villages and number of eligible families in each village. From the list, villages with less than 5 pregnant women or children below 6 months of age were excluded. Using the final list of villages, 130 villages will be randomly selected and randomly allocated to each of the two main study arms using computer‐generated random numbers. Within the treatment arm, half of the villages will be randomized to regular or encouragement treatment conditions. CONDITION: Iron deficiency anemia in children, low breastfeeding rates, poor complementary feeding practices and poor caregiver mental health ; Haematological Disorders PRIMARY OUTCOME: ; At baseline, 6‐months, and 12‐months:; 1. Hemoglobin concentration among children aged 0 – 18 months, measured by HemoCue 201+ test; 2. Exclusive breastfeeding under 6 months: proportion of children aged < 6 months who received only breastmilk in the previous day, measured by caregiver questionnaire; 3. Dietary diversity: number of food groups received by children aged 6 – 18 months in the previous day, measured by caregiver questionnaire; SECONDARY OUTCOME: ; At baseline, 6‐months, and 12‐months:; 1. Child Health, including:; 1.1 BMI z‐scores among children aged < 18 months, measured by physical exam; 1.2 Anemia status among children aged < 18 months, measured by HemoCue 201+ test; 1.3 Incidence of illness or injury among children aged < 18 months, measured by caregiver questionnaire; 2. Child Feeding Practice, measured by caregiver questionnaire; 3. Attitude, Efficacy, and Knowledge, measured by caregiver questionnaire; 4. Health Care Utilization, measured by caregiver questionnaire; 5. Maternal Well‐being, measured by caregiver questionnaire; INCLUSION CRITERIA: 1. Pregnant women or caregivers of children 0 to 6 months of age 2. Wiling to participate in the HF program 3. Willing to participate in the impact evaluation, including the household surveys, anthropometric measures, and hemoglobin tests 4. Ability and willingness to give informed oral consent