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The Invisible Fishers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03498755
Recruitment Status : Completed
First Posted : April 17, 2018
Last Update Posted : August 26, 2019
Sponsor:
Collaborators:
University of Ghana
Innovations for Poverty Action
Netherlands Development Organization
Viamo
Bill and Melinda Gates Foundation
Information provided by (Responsible Party):
Andrew Jones, University of Michigan

Brief Summary:
This pilot study aims to introduce three interventions directed toward mitigating anemia among women in Ghana, including: 1) multi-sectoral behavior change, 2) strengthening market engagement of fish processors, 3) improving fish smoking technology and practices. These interventions will be implemented among female fish processors, a population that represents a promising focal area for intervention within fisheries value chains, which have been identified as a uniquely promising sector for intervention to mitigate anemia among women. The investigators expect that the findings from this study will inform understanding of how best to design, implement, and evaluate interventions into fisheries and other animal-source food value chains in Ghana and across sub-Saharan Africa to address anemia and other nutritional and health concerns.

Condition or disease Intervention/treatment Phase
Anemia Behavioral: Mobile phone audio messaging Behavioral: Peer-to-peer learning Behavioral: Conditional cash transfer Behavioral: Entrepreneurship training Behavioral: Market price information Behavioral: Improved smoke ovens Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Two communities in each of two study regions will be assigned to one of the three treatments (i.e., six communities in total per region). Assigning two communities to the same treatment in each region will allow us to assess differential intervention design and implementation needs for communities in similar geographic areas. Ten women in each community will be purposefully selected for participation to ensure intra-community variation on participant age, socioeconomic status, years of experience with fish smoking, and the scale of fish smoking enterprises. Across both regions, 120 women will be recruited from a total of 12 communities. While the interventions will be delivered to individual women, treatment assignment will be carried out at the community-level given the risk of sharing information and inputs within communities that could contaminate intervention exposure and bias observed treatment effects.
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: The Invisible Fishers: Empowering and Safeguarding Women in Fisheries Value Chains in Ghana to Reduce Anemia
Actual Study Start Date : May 21, 2018
Actual Primary Completion Date : August 17, 2019
Actual Study Completion Date : August 17, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Anemia

Arm Intervention/treatment
Experimental: Multi-sectoral anemia behavior change
Address multiple behavioral determinants of anemia by promoting the identification, knowledge, valuation and practice of four behavioral domains: 1) consumption of micronutrient-rich animal-source foods; 2) malaria and soil-transmitted helminth infection control practices; 3) water, sanitation and hygiene (WASH) best practices; and 4) women's autonomy in decision-making and control of the use of earned income.
Behavioral: Mobile phone audio messaging
Audio messages will be "pushed" to participants' mobile phones twice weekly on a set schedule in discrete modules that include basic information related to each of the four behavioral domains followed by an integration of the information across behaviors through relatable, character-driven narratives that enable message recipients to engage with the content through a real-world context.

Behavioral: Peer-to-peer learning
Women participants in each community will meet twice monthly for peer-to-peer learning sessions to reinforce the content of audio messages. These sessions will further use women's empowerment approaches including critical examination of gender dynamics, and discussions of solutions for equitable decision-making and control of resources within households. These discussions will be facilitated with male household members and grandmothers in separate learning sessions that will be held three times throughout the intervention period.

Experimental: Strengthening market engagement of fish processors
Assist women in overcoming limited access to credit, inadequate storage facilities, and insufficient information about market prices, which constrain the timeliness and amount of market-ready product available for sale, through a three-pronged approach that includes: 1) a conditional cash transfer; 2) entrepreneurship training; and 3) enhanced access to market price information.
Behavioral: Mobile phone audio messaging
Audio messages will be "pushed" to participants' mobile phones twice weekly on a set schedule in discrete modules that include basic information related to each of the four behavioral domains followed by an integration of the information across behaviors through relatable, character-driven narratives that enable message recipients to engage with the content through a real-world context.

Behavioral: Peer-to-peer learning
Women participants in each community will meet twice monthly for peer-to-peer learning sessions to reinforce the content of audio messages. These sessions will further use women's empowerment approaches including critical examination of gender dynamics, and discussions of solutions for equitable decision-making and control of resources within households. These discussions will be facilitated with male household members and grandmothers in separate learning sessions that will be held three times throughout the intervention period.

Behavioral: Conditional cash transfer
Participants will receive a conditional cash transfer to support their fish smoking business. The payment will be conditional on their participation in entrepreneurship trainings and the use of the investment into their fish smoking business.

Behavioral: Entrepreneurship training
Entrepreneurship training will focus on commonly lacking business knowledge, with an emphasis on establishing fundamental entrepreneurial skills (i.e., customer care, accounting), sound business management and decision-making, building strong and sustainable business relationships, and encouraging the use of loans for their intended purposes. This training will be introduced during the credit and savings group (CSG) meetings that will occur twice per month.

Behavioral: Market price information
Average market prices for fresh and processed fish at community, district, and regional markets will be disseminated via audio message calls (using Viamo's Infoline platform) to the mobile phones of women with the price information in their preferred language. These market prices will be collected twice weekly by Viamo field enumerators and sent to regional coordinators for validation. A second, independent validation will be carried out to ensure that there are no discrepancies.

Experimental: Improving fish smoking technology and practices
Introduce and promote a recently developed fish smoking oven known as the Ahotor, which was explicitly designed to reduce emission from biomass fuel combustion, decrease polycyclic aromatic hydrocarbon (PAH) levels of smoked fish, and increase fuel efficiency. Use of this oven will reduce workload, increase earnings, and reduce harmful occupational exposures. Introduction of this improved fish smoking oven will be combined with behavior change education focused on promoting optimal fish smoking and handling practices.
Behavioral: Mobile phone audio messaging
Audio messages will be "pushed" to participants' mobile phones twice weekly on a set schedule in discrete modules that include basic information related to each of the four behavioral domains followed by an integration of the information across behaviors through relatable, character-driven narratives that enable message recipients to engage with the content through a real-world context.

Behavioral: Peer-to-peer learning
Women participants in each community will meet twice monthly for peer-to-peer learning sessions to reinforce the content of audio messages. These sessions will further use women's empowerment approaches including critical examination of gender dynamics, and discussions of solutions for equitable decision-making and control of resources within households. These discussions will be facilitated with male household members and grandmothers in separate learning sessions that will be held three times throughout the intervention period.

Behavioral: Improved smoke ovens
Local private sector artisans will construct and serve as suppliers of the new ovens. The promotion, uptake and impact of these improved Ahotor ovens will be tested among study participants. Awareness-raising workshops held in each community will promote the Ahotor in concert with a public retrofitting of a Chorkor stove. Immediately following this event, one month later, and three months later, study participants will receive additional one-on-one counseling to provide further support on the proper use of the smoke oven, as well as on optimal handling and smoking practices to enhance product quality.




Primary Outcome Measures :
  1. Change in anemia over time [ Time Frame: Change from baseline anemia status over the 9 months of the intervention ]
    Hemoglobin (Hb) <120 g/L, based on analysis of blood and stool samples


Secondary Outcome Measures :
  1. Change in knowledge and value of animal-source foods for health over time [ Time Frame: Change from baseline knowledge over the 9 months of the intervention ]
    Evaluated from participants' responses to assessment related to content of audio messages and peer-to-peer learning

  2. Change in amount of processed fish kept for own consumption [ Time Frame: Change from baseline amount of fish over the 9 months of the intervention ]
    Collected daily using participants' business diaries

  3. Change in animal-source food purchases [ Time Frame: Change from baseline purchases over the 9 months of the intervention ]
    Collected using a seven-day animal-source food expenditure questionnaire

  4. Change in consumption of animal-source food [ Time Frame: Change from baseline consumption over the 9 months of the intervention ]
    Collected using a 24-hour dietary recall questionnaire on three non-consecutive days in a one-week period

  5. Change in understanding and valuation of the importance of specific practices for improving environmental and personal hygiene and minimizing risk of infection [ Time Frame: Change from baseline understanding over the 9 months of the intervention ]
    Participant recall and observation of use of insecticide-treated bed nets for sleeping, recent anti-malaria indoor residual spraying of household, frequency and location of barefoot travel, handwashing with soap, safe disposal of stool, treatment of drinking water, safe food and storage preparation practices, and personal hygiene

  6. Change in women's autonomy in decision-making and control over earned income [ Time Frame: Change from baseline autonomy over the 9 months of the intervention ]
    Measure of women's access to productive capital and the role of women in household decision-making related to agricultural production and income generation, as assessed by a questionnaire of the Women's Empowerment in Agriculture Index

  7. Change in smoked fish production and processing capacity [ Time Frame: Change from baseline production and capacity over the 9 months of the intervention ]
    Assessed from daily business diaries and participant recall for cross-validation

  8. Change in fish sales and income generation from fish sales [ Time Frame: Change from baseline sales over the 9 months of the intervention ]
    Assessed from daily business diaries and participant recall for cross-validation

  9. Change in fuelwood and other fish processing business-related expenditures [ Time Frame: Change from baseline expenditures over the 9 months of the intervention ]
    Assessed from daily business diaries and participant recall for cross-validation

  10. Change in knowledge of entrepreneurial skills and best business practices [ Time Frame: Change from baseline knowledge and practices over the 9 months of the intervention ]
    Examined using assessment tool that evaluates knowledge of customer care, calculating profits, managing inventory, and accounting

  11. Change in perceptions of positive and negative changes resulting from participation in interventions [ Time Frame: Change from baseline perceptions over the 9 months of the intervention ]
    Measured from extent to which women used market price information that was disseminated via mobile phones, changes in women's business practices, and women's perceptions of the reasons for changes in fish processing, sales, and/or income from fish sales

  12. Change in exposure to PM2.5 (particulate matter less than 2.5 microns in aerodynamic diameter) and CO (carbon monoxide) [ Time Frame: Change from baseline exposure over the 9 months of the intervention ]
    Primary exposure will be calculated as the mean of recorded concentrations during fish smoking activities (determined by participant time use diaries and corroborated with observational data). Secondary exposure will be calculated as the mean of recorded concentrations during the full 48-hour exposure measurement period

  13. Change in work environments during fish processing including individuals participating in processing activities [ Time Frame: Change from baseline environments over the 9 months of the intervention ]
    Assessed from observation data

  14. Change in knowledge of optimal fish handling and smoking practices for enhancing product quality [ Time Frame: Change from baseline knowledge over the 9 months of the intervention ]
    Assessed using custom tool based on the content of community promotional activities and one-on-one counseling sessions

  15. Change in type of fish smoking oven used [ Time Frame: Change from baseline oven used over the 9 months of the intervention ]
    Assessed from observational data

  16. Women's perceptions of the ease of use of Ahotor oven relative to their prior stoves [ Time Frame: At the end of study (10 months) ]
    Assessed using a semi-structured interview guide through in-person interview with subsample of participants in treatment arm 3

  17. Women's perceptions of the functionality of the new oven [ Time Frame: At the end of study (10 months) ]
    Assessed using a semi-structured interview guide through in-person interview with subsample of participants in treatment arm 3

  18. Differences in home cooking patterns following adoption of new ovens [ Time Frame: At the end of study (10 months) ]
    Assessed using a semi-structured interview guide through in-person interview with subsample of participants in treatment arm 3



Information from the National Library of Medicine

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Ages Eligible for Study:   15 Years to 49 Years   (Child, Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Not pregnant
  • Not planning to move from the community during the project period
  • Engaged in fish processing as primary livelihood

Exclusion Criteria:

  • Pregnant
  • Planning to move from the community during the project period
  • Not engaged in fish processing as primary livelihood

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03498755


Locations
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Ghana
University of Ghana, Legon
Accra, Ghana
Sponsors and Collaborators
University of Michigan
University of Ghana
Innovations for Poverty Action
Netherlands Development Organization
Viamo
Bill and Melinda Gates Foundation

Additional Information:
Publications:
World Health Organization. The global prevalence of anaemia in 2011. Geneva, Switzerland: World Health Organization, 2015.
World Health Organization. Worldwide prevalence of anaemia, 1993-2005. Geneva, Switzerland: World Health Organization, 2008.
International Food Policy Research Institute. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, DC: International Food Policy Research Institute, 2016.
Ezzati M, Lopez AD, Rodgers AA, Murray CJL. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva, Switzerland: World Health Organization, 2004.
Horton S, Ross J. The economics of iron deficiency. Food Policy. 2003;28(1):51-75.
Nyantakyi-Frompong H, Colecraft E, Awuah R, Boatemaa S, Kushitor M, Adam Y, et al. Leveraging livestock production to address anemia without increasing exposure to adverse health threats: A multisite qualitative study in Ghana. (under review).
Pathways to Anemia Prevention Study Team. Pathways to Anemia Prevention Study Field Report. Tamale, Ghana: Innovations for Poverty Action, 2017.
Allison EH, Delaporte A, Hellebrandt de Silva D. Integrating fisheries management and aquaculture development with food security and livelihoods for the poor. Report submitted to the Rockefeller Foundation. Norwich, UK: School of International Development, University of East Anglia, 2013.
High Level Panel of Experts on Food Security and Nutrition. Sustainable fisheries and aquaculture for food security and nutrition. Rome, Italy: FAO, 2014.
World Bank. Adwoa Adezawa: The Young Woman and the Sea. Washington, DC: World Bank; 2017 [updated March 22, 2017.
Williams SB, editor Economic Potentials of Women in Small-scale Fisheries in West Africa. IIFET 2000 Proceedings; 2000.
FAO. The state of world fisheries and aquaculture 2014. Rome, Italy: FAO, 2014.
World Bank, FAO, WorldFish. Hidden harvest: the global contribution of capture fisheries. Washington, DC: World Bank, 2012.
Koranteng KA. The Ghanaian fishery for sardinellas. In: Bard FX, Koranteng KA, editors. Dynamics and Use of Sardinella Resources from Upwelling off Ghana and Ivory Coast: Acts of DUSRU Meeting. ORSTOM, Colloque DUSRU, 5-8 Oct 1993, Accra, Ghana. Paris, France: ORSTOM Editions; 1995. p. 243-58.
UNDP, FAO. Improved fish smoking: Ghana. In: UNDP, FAO, editors. Sharing Innovative Experiences Volume 5, Examples of Successful Initiatives in Agriculture and Rural Development in the South. Rome, Italy: UNDP, Special Unit for Technical Cooperation among Developing Countries; 2001.
Overa R. Partners and Competitors: Gendered Entrepreneurship in Ghanaian Canoe Fisheries: University of Bergen; 1998.
Gordon A, Pulis A, Owusu-Adjei E. Smoked marine fish from Western Region, Ghana: a value chain assessment. Ghana: WorldFish Center, USAID Integrated Coastal and Fisheries Governance Initiative for the Western Region, 2011.
Béné C, Russell AJM. Diagnostic study of the Volta Basin fisheries, Part 2: Livelihoods and poverty analysis, current trends and projections. Cairo, Egypt: WorldFish Center Regional Offices for Africa and West Asia, 2007.
Patel A. Household Air Pollution. In: Landrigan PJ, Etzel RA, editors. Textbook of Children's Environmental Health. Oxford, UK: Oxford University Press; 2003.
Flintwood-Brace A. Biomass Smoke Exposure in Traditional Smokehouses and Respiratory Symptoms Among Fish Smokers at Aboadze/Abuesi in the Western Region of Ghana: University of Ghana; 2016.
Ghana Statistical Service, Ghana Health Service, ICF International. Ghana Demographic and Health Survey 2014 Rockville, MD: GSS, GHS, and ICF International, 2015.
Rubin H, Rubin I. Qualitative Interviewing: the Art of Hearing Data. Thousand Oaks, California: Sage; 2005.
SPRING, Ghana Health Service. Ghana: Landscape Analysis of Anemia and Anemia Programming. Arlington, VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, 2016.
Global Panel on Agriculture and Food Systems for Nutrition. Food systems and diets: Facing the challenges of the 21st century. London, UK: Global Panel on Agriculture and Food Systems for Nutrition, 2016.
World Health Organization. Soil-transmitted helminth infections Geneva, Switzerland: World Health Organization; 2017.
Ghana Health Service. National malaria control programme: 2010 Annual Report. Accra, Ghana: Ghana Health Service, 2010.
Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice Edition. San Francisco, CA: Wiley, John & Sons, Inc.; 2008.
Manoff Group. Defining Social and Behavior Change Communication and Other Essential Health Communication Terms. Washington, DC: Manoff Group.
World Bank. From Agriculture to Nutrition: Pathways, Synergies, and Outcomes Washington, DC: World Bank, 2007.
Pathways to Anemia Prevention Study Team. Pathways to Anemia Prevention Study: Report On Results Dissemination and Consensus Building Workshop Accra, Ghana: University of Ghana, 2017.
Waddington H, Snilstveit B, White H, Fewtrell L. Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries. Washington, DC: International Initiative for Impact Evaluation (3ie), 2009.
van den Bold M, Quisumbing AR, Gillespie S. Women's Empowerment and Nutrition: An Evidence Review. Washington, DC: International Food Policy Research Institute, 2013.
Kennedy E, Cogill B. Income and Nutritional Effects of the Commercialization of Agriculture in Southwestern Kenya. Washington, DC: International Food Policy Research Institute, 1987.
Quisumbing AR, Brown L, Feldstein H, Haddad LJ, Pena C. Women: The Key to Food Security. Washington, DC: International Food Policy Research Institute, 1995.
The Impact of Non-Traditional Export Agriculture on Income and Food Availability in Guatemala: An Intra-Household Perspective, (1994).
Colecraft EK, Marquis GS, Sakyi-Dawson O, Lartey A, Butler LM, Ahunu B, et al. Planning, design and implementation of the enhancing child nutrition through animal source food management (ENAM) project. African Journal of Food, Agriculture, Nutrition and Development. 2012;12(1):5687-708.
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Akapule S. Information Technology Platform Launched in Upper East Region. Ghana News Agency. 2017.
SPRING, Ghana Health Service. Health Worker Training Manual for Anaemia Control in Ghana. Accra, Ghana: SPRING and Ghana Health Service, 2017.
Lamstein S, Stillman T, Koniz-Booher P, Aakesson A, Collaiezzi B, Williams T, et al. Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia: Report from a Systematic Literature Review. Arlington, VA: USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project, 2014.
Aubel J. The roles and influence of grandmothers and men: Evidence supporting a family-focused approach to optimal infant and young child nutrition. Washington, DC: PATH, CARE, Manoff Group, University Research Co., 2011.
CARE International. Women's Empowerment and Engaging Men. Atlanta, GA: CARE International, 2009.
Gibson RS. Principles of nutritional assessment. New York, NY: Oxford University Press; 2005.
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Cho Y, Honorati M. Entrepreneurship Programs in Developing Countries: A Meta Regression Analysis. Washington, DC: World Bank, 2013.
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IFC, G-20 Global Partnership for Financial Inclusion (GPFI). Strengthening access to finance for women-owned small and medium-sized enterprises (SMEs) in developing countries. Washington, DC: GPFI, 2011.
De Mel S, McKenzie D, Woodruff C. Business training and female enterprise startup, growth, and dynamics: Experimental evidence from Sri Lanka. Washington, DC: World Bank, 2012.
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Institute for Industrial Research - CSIR, Ghana Standard Authority, Kwarteng E. Testing of Low PAH Improve Fish Smoking Stove (Ahotor oven). Narragansett, RI: USAID/Ghana Sustainable Fisheries Management Project (SFMP), Coastal Resources Center, Graduate School of Oceanography, University of Rhode Island, 2016.
Netherlands Development Organization. Introducing the Ahotor oven in the Volta region of Ghana. 2017.
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: World Health Organization, 2011.
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Herforth A, Jones A, Pinstrup-Andersen P. Prioritizing Nutrition in Agriculture and Rural Development: Guiding Principles for Operational Investments. Washington, DC: World Bank, 2012.
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Responsible Party: Andrew Jones, Assistant Professor, University of Michigan
ClinicalTrials.gov Identifier: NCT03498755    
Other Study ID Numbers: HUM00138934
First Posted: April 17, 2018    Key Record Dates
Last Update Posted: August 26, 2019
Last Verified: August 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Andrew Jones, University of Michigan:
fisheries
Ghana
sub-Saharan Africa
value chain
fish processing
fish smoking
Additional relevant MeSH terms:
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Anemia
Hematologic Diseases