Parental Misperceptions on Child Nutrition in India: Implications for Child Feeding Practices and Growth

Condition(s) studied

Investigational drug(s) / intervention(s)

Information on Relative Nutritional Status: The intervention involves providing information on the height-for-age and weight-for-age percentiles of children relative to a reference group of healthy children based on WHO standards

Information on Returns to Child Nutrition: The intervention involves providing information on the effects of child undernutrition on long-term health, education, and labor market outcomes.

Study summary

The goal of this randomized controlled trial is to examine the role of parental misperceptions and information gaps in contributing to poor child dietary practices and high child undernutrition rates in India. The main research questions it seeks to answer are:

1. Do mothers systematically overestimate the nutritional status (height- and weight-for-age percentiles) of their children, relative to global World Health Organization (WHO) standards and other children in their region?,
2. Do mothers underestimate the returns to child nutrition on long-term health, education, and labor market outcomes?,
3. What mechanisms could explain the formation of such misperceptions? Are mothers with higher exposure to undernourished children more likely to overestimate their children's nutritional status?, and
4. Would updating mothers' beliefs about a) their children's true height-for-age and weight-for-age percentiles, and/or b) the returns to child nutrition, improve child feeding practices, utilization of government nutrition services, and child growth outcomes?

The study involves an individual-level randomized controlled trial with 1500 mothers of children aged 7-24 months in Telangana, India, with two information treatment arms and one control arm. The first treatment will update mothers' beliefs on the relative height- and weight-for-age percentiles of their children, and the second will provide information on the impacts of child undernutrition on long-term health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes.

The treatment and control groups will be compared to assess if the information treatments improve outcomes related to child feeding practices, consumption of government-supplied therapeutic food, cognition measures, and child growth.

Eligibility

Primary outcome measure(s)

• Average willingness-to-pay for protein-rich food bundle — Baseline
  All mothers who participate in the survey will be entered into a lottery to win a bundle of protein-rich food items for their child or, alternatively, a randomly chosen cash prize (amount may range from Rs. 100 to Rs. 2000). 25 lottery "winners" will be chosen randomly at the end of the baseline survey. Mothers will be asked to state their preferences between the food bundle and several potential cash prize amounts, using a multiple-price-list elicitation method. One cash prize amount will be randomly chosen for each mother, and their choice for that amount will be implemented in case they win the lottery. WTP will be measured by the mid-point of the interval of two cash amounts at which a mother switches from preferring to receive cash to preferring to receive food. Possible values range from 0 to 2000. Average willingness-to-pay will be compared between mothers in the treatment groups and the control group.
• Difference between true and perceived height-for-age percentile relative to WHO standards — During endline survey, an average of 4 months (or 17 weeks) from baseline
  The difference between the child's true height-for-age percentile relative to the WHO reference population and the mother's perceived percentile rank. Values may range from 0 to 100.
• Difference between true and perceived weight-for-age percentile relative to WHO standards — During endline survey, an average of 4 months (or 17 weeks) from baseline
  The difference between the child's true weight-for-age percentile relative to the WHO reference population and the mother's perceived percentile rank. Values may range from 0 to 100.
• Knowledge score on returns to child nutrition (Binary) — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Binary variable coded "1" if at least half the prompts (3 out of 6) about the returns to child nutrition are answered correctly, and "0" otherwise. This is a binary indicator constructed based on the knowledge score scale that may range from 0 to 6, with higher scores representing better knowledge.
• Minimum frequency of meals — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Binary variable coded "1" if the child consumed the minimum recommended number of meals in the last 24 hours, based on their age, and "0" otherwise
• Minimum dietary diversity — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Binary variable coded "1" if the child consumed food from at least 5 of the 8 specified food groups in the last 24 hours, and "0" otherwise. This is a binary indicator constructed based on the World Health Organization "Minimum Dietary Diversity - Infant and Young Child Feeding" (MDD-IYCF) scale. Scores may range from 0 to 8, with higher scores representing better outcomes.
• Height-for-age z-score — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Height-for-age z-score at the time of the endline survey
• Weight-for-age z-score — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Weight-for-age z-score at the time of the endline survey
• Weight-for-height z-score — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Weight-for-height z-score at the time of the endline survey
• Consumption of Balamrutham — During endline survey, an average of 4 months (or 17 weeks) from baseline
  Binary variable coded "1" if the child consumed Balamrutham (government-provided therapeutic food) in the last 24 hours, and "0" otherwise
• CREDI child cognition scale z-score — During endline survey, an average of 4 months (or 17 weeks) from baseline
  The Caregiver-Reported Early Development Instruments (CREDI) Short Form is a validated set of 20 population-level measures of early childhood development (ECD) for children from birth to age three (0-36 months). The responses on this 20-point scale (based on age) will be converted to a norm-referenced standardized Z-score for overall development. The z-scores may range from -6 to +6, with larger scores representing better outcomes.

Trial sites (1)