Feed the FutureGlobally, while child stunting has been falling, the prevalence of acute malnutrition has remained stubbornly high and resistant to change.  The One Nutrition in Complex Environments (ONCE) study is a cluster-randomized trial that tests a new way of preventing and addressing acute malnutrition. The study has three aims:

  1. Implement and test an existing social and behavior change approach free-standing and in combination with a “value-added” integrated approach.
  2. Identify best-practices emerging from the implementation of the two approaches.
  3. Study the sustained impact of each approach on knowledge and practices one year after the intervention.

The three study arms are:

  • NIPP Group: This arm will participate in GOAL’s Nutrition Impact and Positive Practice (NIPP).
  • NIPP Plus Group: This arm will participate in NIPP and will be introduced to simple innovations to encourage the households and communities to translate the knowledge into positive practices.
  • Control Group: This arm will not participate in NIPP, nor will they be introduced to the simple innovations.

See Interventions tab for more information.

The American people support this study through the Feed the Future initiative.


Nutrition Impact and Positive Practice (NIPP) Approach

One group will participate in NIPP. It is a gendered, grass-roots social behavior change (SBC) approach that directly tackles a set of underlying causes of malnutrition. NIPP aims to prevent child malnutrition and encourage treatment of existing cases. The approach involves creating circles of female, male, and community leaders that meet separately for 12 weeks to receive participatory behavior change education reinforced by practical activities. It uses easy, viable, and accessible solutions within the community  to improve and protect household health and nutrition. More information about NIPP is available here.

The NIPP Plus Approach

The second study group will participate in the NIPP approach as outlined above and will learn about simple innovations to enable and encourage the households and communities to translate the knowledge into positive practices. The innovations include a) water quality self-assessment tools, b) simple diagnostics and tools for management of human and livestock health, c) hygrometers and hermetic, portable, and re-usable storage bags that will help ensure grain is dry thus lowering the risk of aflatoxin contamination, d) new seed varieties (e.g. drought tolerant, stress resistant), and d) pre- and post-harvest agricultural management practices. Most of the additions will be made accessible at a subsidized/low cost.

Tufts University leads the consortium, overseeing all aspects of study planning,  implementation, data collection and management, statistical analysis, and reporting. Tufts also leads on water quality component of the NIPP Plus approach, which includes developing the training modules and collecting the water samples. It also leads on the research uptake aspects of the study.

GOAL Global is responsible for the implementation of the interventions and the data collection required for process monitoring, impact evaluation, and qualitative assessments. GOAL is an international humanitarian aid agency dedicated to alleviating the suffering of the world’s most vulnerable communities. It has operated for 40 years in 15 countries.

CIMMYT supports the development of the protocols and the implementation of the agriculture interventions. CIMMYT is a research and development organization working on maize. In East Africa, its research and development efforts focus on breeding stress tolerant maize varieties, improved crop management, post-harvest management, and evaluation and economic impact assessment of these technologies.

The Division of Nutritional Sciences (DNS) at Cornell University will develop the aflatoxin assessment kit and smartphone app.  DNS is among the largest academic units in the U.S. devoted to human nutrition.

This study is made possible through support provided by the Office of Acquisition and Assistance, Bureau for Management, U.S. Agency for International Development, under the terms of Cooperative Agreement No. AID‐OAA‐L‐10‐00006. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development.