Article Figures & Data
Figures
- Figure 1. Trial flow diagram
Tables
Control clinics Intervention clinics Mother–child care Usual care Standard counselling session on childhood nutrition, development, and maternal mental health, using pictorial flipbook.
Monitoring and screening of child growth and maternal mental health.
Assessment and treatment (including referral to specialist) of childhood nutrition, development, or maternal depression.
Follow-up of mother–child pairs in clinic at 3, 6 and 9 months (including SMS or telephone reminder, if required)
Low dose vitamin A Yes Yes Community advocates Yes Yes Branding of clinic by Directorate General Health Services Yes Yes Training of private doctors (GPs) and clinic assistants Control clinic staff will receive basic training only, focused on the correct use of study recording forms, with a general overview of the importance of childhood development and maternal health; that is, they will not receive any specific training on intervention activities. Clinic assistants will be trained by project field coordinator (under supervision of project manager and specialist doctor) using the study clinical assistant training protocol (CATP), which includes:
how to conduct a standardised counselling session using the flipbook;
how to administer the PHQ-2; and
how to measure and record child length and weight.
Private GPs will be trained by an experienced specialist according to the study private doctor training protocol (PDTP), which includes:
clinical management of children with malnutrition and developmental delay in the private clinic setting;
how to use PHQ-9 for the diagnosis of maternal depression; and
how to assess the mother–child pair for a specialist referral, when required, to the appropriate public tertiary care facility.
The training protocols, both CATP and PDTP, are developed by a group of local experts and specialists, adapted from international best-practice guidelines and standards.16,17
Training will last approximately 2 hours, and will include a mixture of explanation by the project field coordinator, and role-play exercises by participants.
- Box 2. Logic model for proposed intervention mechanisms/theory of change (adapted from Bonell and colleagues 2015)38
Inputs Processes and actions Intended changes (Theoretical domains framework)21 Intended outputs Intended health outcomes Intervention Formative research: interviews with providers, mothers, and key stakeholders
Consultation with experts to develop technical materials:
• Training protocols and manuals
• Counselling flipbook
• Community advocate leaflets
Training of private GPs and clinic assistants: theoretical and practical trainingQuarterly counselling sessions for mothers (child development, child nutrition, maternal mental health)
Quarterly child growth monitoring
Text message/SMS reminders to mothers for quarterly follow-up appointments
Assessment and treatment of chid developmental delay (may include referral)
Assessment and treatment of maternal depression (may include)Mother
Social influences
Knowledge
Beliefs about consequences
Environmental context and resources
Reinforcement
Private GP and clinic assistant
Social influences
Knowledge
Skills
Environmental context and resources
Social and professional role and identityMother
Mother–child health services are accessible and desirable to mother
Increased capability and confidence to support child nutrition and development in the home environment
Increased capability and confidence to protect own mental health in the home environment
Private GP and clinic assistant
Motivated and skilled to provide mother–child health servicesReduced developmental delay at 12 months of age (primary outcome)
Improved childhood nutrition
Reduced maternal depressionBoth intervention and control arms DGHS endorsement of intervention and control clinics
Identification and orientation of community advocates
Growth Monitoring Cards to intervention and control clinics
Standard calibrated equipment to intervention and control clinics
Supervision of data entry on Growth Monitoring Card by clinic assistant (Field research officer)Recruitment of mothers by community advocates
Vitamin A supplementAdequate participant recruitment
High quality data
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