SPRING Programme Grant: Enhancement application for additional funds (360G-Wellcome-093615_Z_10_A)

The goal of SPRING, Sustainable Programme Incorporating Nutrition & Games, is to develop an innovative, feasible, affordable and sustainable approach that can achieve delivery at scale of known effective interventions to maximise child development, growth and survival by using existing community-based agents (CBAs) in India and Pakistan. The SPRING intervention will be developed through extensive formative research, holding an intervention development workshop with local and international stakeh olders and experts to review the findings and make decisions about intervention content and structure, and by piloting the intervention with a few CBAs and their supervisors in order to test all operational elements. The resulting intervention will be evaluated through cluster randomised controlled trials in each setting, each involving 20 CBA supervisory zones, with 15-25 CBAs per zone, and recruiting 300 newborns per zone (a random subsample of 100 will have growth and development assessments) . Primary outcomes are infant mortality, maternal psychosocial distress at 6 months, quality of the home environment and maternal/child interaction at 1 year, and stunting and child development at 2 years. The programme will include detailed process and economic evaluations with both cost effectiveness and total cost analyses, and development of a framework for scale up to other settings.