A Grant Proposal to assess the impact of women’s empowerment in enhancing infant and young child feeding and sanitation practices to address stunting among children under 5 years old in the Amhara region in Ethiopia Pubblico
Orgle, Jennifer Naana (Spring 2020)
Abstract
Stunting is the most chronic form of malnutrition and has far reaching consequences, affecting individuals, families, societies and the nation. Known to occur within the first 1,000 days of live and almost impossible to reverse after 24 months, childhood stunting is associated with impaired cognitive development, poor school performance, reduced lifetime earnings and the perpetuation of the intergenerational cycle of poverty. Globally WHO estimates that there are over 150 stunted children. With stunting rates as high as 38% nationally and 46% (6% above the WHO cut off point for ‘alarming stunting rates’) in Amhara region, 1 in 15 children will die before they reach their fifth birthday. Despite declining rates of stunting globally and in Ethiopia, evidence suggests that these are not enough to meet the WHO global target of 100 million stunted children by 2025(Schmidt, 2014)(Schmidt, 2014)(Schmidt, 2014)(Schmidt, 2014)(Schmidt, 2014)(Schmidt, 2014)(Schmidt, 2014).
Key among the multifaceted causes of stunting are sub-optimal feeding practices, poor sanitation, leading to Environmental Enteric Dysfunction (EED) and women’s socio-economic status. Many interventions have failed to recognize the impact of women’s socio-economic status on nutritional outcomes and this proposal hypothesizes that previous stunting interventions have not achieved significant impact due to the lack or limited focus of women’s empowerment interventions. This is because although women tend to be the primary caregivers men control decision making and resources that impact nutrition. This proposal will test the impact of women’s empowerment on enhancing infant and young child feeding and reducing infant faecal exposure in reducing stunting. It will answer the question, “Does women’s empowerment improve sanitation and feeding practices and consequently stunting outcomes?”
Proposed interventions will reach a total of 20,000 household in 40 sub-districts in 2 districts. A study sample of 3,638 will be drawn from the intervention population and a further 1,819 from a third woreda that would act as a control site. In all, 5,457 child and caregiver pairs will be recruited for the study.
Table of Contents
1 INTRODUCTION ............................................................................................................................ 1
1.1 INTRODUCTION AND RATIONALE ............................................................................................................ 1
1.2 PROBLEM STATEMENT ......................................................................................................................... 2
1.3 RESULTS FRAMEWORK ......................................................................................................................... 3
1.4 PURPOSE STATEMENT .......................................................................................................................... 3
1.5 SIGNIFICANCE STATEMENT .................................................................................................................... 4
1.6 DEFINITION OF TERMS ......................................................................................................................... 4
2 LITERATURE REVIEW ..................................................................................................................... 8
2.1 THE PATHOGENESIS OF STUNTING ........................................................................................................... 9
2.2 INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES IN ETHIOPIA ........................................................... 11
2.3 WATER, SANITATION, HYGIENE AND STUNTING ...................................................................................... 13
2.4 ENVIRONMENTAL ENTERIC DYSFUNCTION .............................................................................................. 14
2.4.1 Overview .................................................................................................................................. 14
2.4.2 Pathogenesis of EED ................................................................................................................ 16
2.5 ASSOCIATION BETWEEN EED AND STUNTING .......................................................................................... 18
2.6 COMMUNITY KNOWLEDGE, ATTITUDE AND PRACTICES ............................................................................. 19
2.7 POTENTIAL WASH INTERVENTIONS TO ADDRESS STUNTING ....................................................................... 22
2.8 POTENTIAL INTERVENTIONS TO ADDRESS EED AND STUNTING ................................................................... 22
2.9 WOMEN’S EMPOWERMENT AND CHILD NUTRITIONAL OUTCOMES ............................................................. 27
2.10 WOMEN’S EMPOWERMENT INTERVENTIONS .......................................................................................... 30
2.11 VILLAGE SAVINGS AND LOANS ASSOCIATIONS (VSLA) .............................................................................. 31
2.12 SOCIAL ANALYSIS AND ACTION (SAA) ................................................................................................... 31
2.13 MEASURING WOMEN’S EMPOWERMENT .............................................................................................. 32
2.14 CONCLUSION ................................................................................................................................... 32
3 METHODOLOGY .......................................................................................................................... 34
3.1 BACKGROUND OF FUNDING FOR NUTRITION .......................................................................................... 34
3.2 SUMMARY OF GRANT ANNOUNCEMENT ................................................................................................ 35
3.3 METHODOLOGY FOR THE GRANT REVIEW PROCESS ................................................................................. 37
3.4 GRANT REVIEWERS ........................................................................................................................... 39
3.5 PROTECTION OF HUMAN SUBJECTS ...................................................................................................... 41
3.5.1 Human subjects involvement, characteristics and design ....................................................... 41
3.5.2 Recruiting and informing subjects of study or program .......................................................... 43
3.5.3 Human Specimens and data collection processes ................................................................... 45
3.5.4 Potential Risks to Participants ................................................................................................. 50
3.6 BENEFITS OF THE RESEARCH OR PROGRAM TO HUMAN SUBJECTS AND SOCIETY ............................................ 51
4 INCORPORATING REVIEWER COMMENTS .................................................................................... 53
4.1 REVIEWER 1: AMY WEBB GIRARD ........................................................................................................ 53
4.2 REVIEWER 2: THOMAS SCHAETZEL ....................................................................................................... 58
4.3 REVIEWER 3: MAUREEN MIRUKA ........................................................................................................ 65
4.4 REVIEWER: MAKU OCANSEY DEMUYAKO .............................................................................................. 68
4.5 REVIEWER 5: GLAVDIA GREATCHENS DELVA .......................................................................................... 70
5 GRANT PROPOSAL RESEARCH PLAN ............................................................................................. 74
5.1 ORGANIZATION AND PROJECT INFORMATION ......................................................................................... 74
5.2 DESCRIPTION OF CHALLENGE ............................................................................................................... 74
5.3 DESCRIPTION OF THE PROPOSED INNOVATION ......................................................................................... 77
5.3.1 Study Site/ Arm 1 ‐ Intervention 1 (Improved IYCF + Reduced Exposure to Feces) .................. 79
5.3.2 Study Site/ Arm 2 – Intervention 1 + Women’s Empowerment .............................................. 80
5.3.3 Study Site/ Arm 3 (Tach Gayint) – Control site ........................................................................ 80
5.4 PROPOSED METHODOLOGY ................................................................................................................. 80
5.5 PARTICIPANT TARGETING AND STUDY SAMPLING .................................................................................... 82
5.5.1 Targeting ................................................................................................................................. 82
5.5.2 Sample size calculation ............................................................................................................ 82
5.6 SCALABILITY AND SUSTAINABILITY......................................................................................................... 83
5.7 IMPLEMENTATION PLAN (GANTT CHART) – PLEASE SEE APPENDIX J. ........................................................... 85
5.8 COORDINATION ................................................................................................................................ 85
5.9 MONITORING AND EVALUATION .......................................................................................................... 86
5.10 ORGANIZATIONAL CAPACITY ............................................................................................................... 88
5.11 CO‐CREATION PROCESS ...................................................................................................................... 89
REFERENCES ........................................................................................................................................ 90
APPENDICES ........................................................................................................................................ 97
APPENDIX A: ELEANOR CROOK FOUNDATION REQUEST FOR APPLICATIONS ............................................................... 97
APPENDIX B: REVIEW GUIDE/ SUMMARY ............................................................................................................ 97
APPENDIX C: GENDER EQUALITY FRAMEWORK .................................................................................................... 97
APPENDIX D: PROJECT RESULTS FRAMEWORK ..................................................................................................... 98
APPENDIX E: MANAGEMENT AND STAFFING PLAN ................................................................................................ 99
APPENDIX F: VILLAGE SAVINGS AND LOANS ASSOCIATION (VSLA) DESCRIPTION ...................................................... 100
APPENDIX G: FOOD AND NUTRITION AND SECURITY ‐ SOCIAL ANALYSIS AND ACTION BRIEF (FNS‐SAA) ...................... 100
APPENDIX H: – GROWING THE FUTURE MANUAL (GTF) ..................................................................................... 100
APPENDIX I: LOGICAL FRAMEWORK ................................................................................................................. 101
APPENDIX J: IMPLEMENTATION PLAN/ GANNT CHART ........................................................................................ 107
TABLE OF FIGURES
FIGURE 1‐1 RESULTS FRAMEWORK .......................................................................................................................... 3
FIGURE 1‐2 CONCEPTUAL FRAMEWORK ................................................................................................................... 4
FIGURE 2‐1 TRENDS IN CHILD STUNTING IN ETHIOPIA ................................................................................................. 8
FIGURE 2‐2 CHILD STUNTING BY REGION .................................................................................................................. 9
FIGURE 2‐3 LOCATION OF ANIMALS AROUND THE HOUSEHOLD .................................................................................... 20
FIGURE 2‐4 LOCATION OF ANIMAL FECES AROUND THE HOUSEHOLD ............................................................................. 21
FIGURE 5‐1 BEHAVIOR‐DETERMINANT‐INTERVENTION LOGIC MODEL (BDI) ................................................................. 78
FIGURE 5‐2 MAP OF AMHARA REGION, ETHIOPIA..................................................................................................... 79
About this Master's Thesis
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Primary PDF
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A Grant Proposal to assess the impact of women’s empowerment in enhancing infant and young child feeding and sanitation practices to address stunting among children under 5 years old in the Amhara region in Ethiopia () | 2020-04-22 16:08:16 -0400 |
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Supplemental Files
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Eleanor Crook Foundation: Request for Applications (Appendix A of Thesis) | 2020-04-22 16:08:19 -0400 |
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Proposal Review Guide (Appendix B of Thesis) | 2020-04-22 16:08:23 -0400 |
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Village Savings and Loans Association: Description (Appendix F of Thesis) | 2020-04-22 16:08:27 -0400 |
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Food and Nutrition Security - Social Analysis and Action Description (Appendix G of Thesis) | 2020-04-22 16:08:33 -0400 |
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Growing the Future Manual (Appendix H of Thesis) | 2020-04-22 16:08:44 -0400 |
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