Evaluating the Effectiveness of a Community-Based Intervention to Reduce Stunting among Children under 5 Years in Urban Slums: A Randomized Controlled Trial

Abstract

Background:
Stunting is a critical public health issue, affecting the physical and cognitive development of children under 5 years. Urban slums often experience higher prevalence due to poor nutrition, hygiene, and limited access to healthcare. This study evaluates the effectiveness of a community-based intervention in reducing stunting prevalence in urban slums using a randomized controlled trial (RCT).

Objective:
To assess whether a multifaceted community-based intervention can significantly reduce stunting prevalence and improve dietary diversity, growth indicators, and caregiver knowledge among children under 5 years in urban slums.

Methods:
• Design: A cluster-randomized controlled trial.
• Participants: Children aged 6–59 months from urban slums (n=1,000), with clusters randomized to intervention (n=500) or control (n=500) groups.
• Intervention: Nutritional education, food supplementation, hygiene promotion, and growth monitoring over 12 months.
• Outcomes:
o Primary: Reduction in stunting prevalence (height-for-age Z-score < -2).
o Secondary: Improvements in dietary diversity scores, caregiver knowledge, and reductions in morbidity.

• Analysis: Mixed-effects logistic regression for stunting prevalence and linear regression for secondary outcomes, adjusted for cluster effects and baseline characteristics.

Results:
• Primary Outcome: Stunting prevalence decreased by 15% in the intervention group compared to 5% in the control group (Adjusted Odds Ratio: 0.65; 95% CI: 0.50–0.85; p<0.001).
• Secondary Outcomes:
o Dietary diversity scores improved significantly in the intervention group (Mean Difference: 1.2; 95% CI: 0.9–1.5; p<0.001).
o Caregiver knowledge scores increased by 30% (p<0.001).
o Morbidity episodes (e.g., diarrhea) reduced by 20% (Incidence Rate Ratio: 0.80; p=0.02).