Protecting Children's Nutritional Gains during a Pandemic: A Study Using Matching Sample Design under a Randomized Controlled Trial in Urban Pakistan

Existing community health worker (CHW) driven public health delivery programs have shown promise in immunization, nutrition, family planning, maternal health, but rarely on child physical growth monitoring. This study provides new evidence of a CHW based nutrition program that directly engages primary caregivers in high-frequency in-home growth monitoring coupled with nutrition counselling. We documented large gains in height-for-age Z-scores (HAZ) for children, an important finding given that the intervention was completed just before the beginning of COVID-19 pandemic and the endline survey was conducted seven months after the intervention. Also, this trial is one of the very few studies done in informal urban settlements areas in resource poor countries. Our findings offer an effective option for policymakers within Pakistan and beyond to address the challenge of stunting and undernutrition, especially in light of the COVID-19 pandemic. We found large positive impacts of high-frequency in-home growth monitoring coupled with nutrition counselling on child anthropometrics. Our in-home procedures were relatively simple, low-cost, compact, and well-documented. Moreover, we trained health workers who were locally recruited, demonstrating that our procedures can be implemented in a low-capacity setting. Given the nutritional consequences of this ongoing pandemic due to the economic shock and disruptions in accessing health facilities, government COVID-19 policy response should prioritize such scalable interventions particularly for vulnerable mothers and children from disadvantaged and marginalized communities.