Feeding PracticesFEFCNCT07146477
A Mixed Methods Study on How Urban Slum Food Environments Influence Caregivers' Feeding Practices for Children Under Five Years in Pune, India
An observational study of Feeding Practices and Food Choices, run by Hirabai Cowasji Jehangir Medical Research Institute at 1 site in India.
Trial summary
The goal of this observational study is to examine how urban slum food environments influence caregivers' feeding practices for children under five years of age in Pune. The main questions it aims to answer are: What are the characteristics of the food environment in selected slums of Pune using the 5 A's framework… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Feeding Practices, Food Choices, Maternal and Child Health
- How many people
- 370 participants
- Where
- 1 siteIndia
- Study dates
- 29 Sep 2025to 30 Jun 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: 1. The study population will consist of Infant and young child caregivers living in slums who have a child or children less than five years of age and had enrolled in an earlier study to assess utilization of maternal healthcare services in these slums. 2. Food vendors (stores, mobile informal vendors and hawkers, and restaurants) who function in the 500 m radius of the household.
Who may be able to join
- For Family Units:
- Families who had participated in the previous house-to-house survey to determine maternal healthcare utilization and infant and young child feeding practices.
- Families where all the female caregivers are willing to participate.
- For Food Vendors:
- Food vendors who regularly carry out business in the 500 m radius of the household.
- Willingness to participate in the study.
Who cannot join
- 1. Families who were a part of the earlier project but have moved out of the survey area.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
India1 site
Hirabai Cowasji Jehangir Medical Research Institute
Pune, Maharashtra, 411001
Rubina M Mandlik
About this study
Official title: From Markets to Meals: A Mixed Methods Study on How Urban Slum Food Environments Influence Caregivers' Feeding Practices for Children Under Five Years in Pune, India
The goal of this observational study is to examine how urban slum food environments influence caregivers' feeding practices for children under five years of age in Pune. The main questions it aims to answer are:
- What are the characteristics of the food environment in selected slums of Pune using the 5 A's framework: availability, accessibility, affordability, acceptability, and accommodation?
- What are caregivers' perceptions of food safety, food prestige, and convenience as additional drivers of food choice within the slum context?
- Are caregivers' aware, and have understanding about the use of packaged food labels, especially in relation to identifying foods for young children?
- How do the local food environment and food choice (FEFC) drivers interact to influence caregivers' feeding practices, with a particular focus on the consumption of unhealthy foods and sugar-sweetened beverages among children under five years of age? Participants will be interviewed using digital forms to assess their food environment and food choice drivers. Anthropometric measurements of all children under five years of age in the household will be taken.
Read the detailed description
In India there is a high prevalence of poor complementary feeding practices. Around 1 in 2 caregivers introduced complementary foods to infants at 6-8 months, while 1 in 4 infants had the minimum dietary diversity, and 1 in 10 consumed the minimum acceptable diet. A worrisome trend being observed is the widespread consumption of ultra-processed foods (UPFs) among children across all socioeconomic groups in India. In informal settlements in Mumbai, nearly 60% children under 6 years were found to be consuming UPFs daily. Increased UPF consumption contributes significantly to the prevalence of double burden of malnutrition in India.
Pune is a rapidly growing mega-city in Maharashtra with a population of 9.4 million, which includes over 1.2 million slum-dwellers, including around 300,000 children under-five years of age. In 2020, only 6% infants had adequate diets and 12% achieved dietary diversity. Specific data is lacking on time of introduction of complementary foods and no data are available on slum-dwelling populations. The United Nations Human Settlements Program defines a slum as "a group of individuals who live under the same roof, and that lack one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living space, the durability of housing, and secure tenure". Slums are a unique and complex ecosystem where caregivers face multiple, intersecting challenges when making food choices for their children. These settings are often marked by limited infrastructure, economic constraints, and a high density of informal food vendors-conditions that may promote the availability and consumption of unhealthy foods.
The food environment defined as "consumer interface within the food system that encompasses the availability, affordability, convenience, quality and promotion, and sustainability of foods and beverages in wild, cultivated, and built spaces" is increasingly recognized as a key determinant of dietary behavior. Yet there is limited evidence from Indian slum settings on how food environments influence infant and young child feeding (IYCF) practices. Most existing research focuses on maternal knowledge or household-level factors, with minimal attention to the broader environmental and structural influences.
This study responds to this gap by assessing the 5 A's of the food environment (availability, accessibility, affordability, acceptability, and accommodation), and by exploring how these dimensions interact with caregivers' perceptions of convenience, food safety, and prestige, as well as their ability to understand and use food labels. These factors are particularly relevant in urban slums, where informal food systems dominate, and where unhealthy foods may be more readily available and aspirationally consumed. Therefore, the objectives of this study are:
- To characterize the food environment in selected slums of Pune using the 5 A's framework: availability, accessibility, affordability, acceptability, and accommodation.
- To explore caregivers' perceptions of food safety, food prestige, and convenience as additional drivers of food choice within the slum context.
- To assess caregivers' awareness, understanding, and use of packaged food labels, especially in relation to identifying foods for young children.
- To examine how the local food environment and food choice drivers interact to influence caregivers' feeding practices, with a particular focus on the consumption of unhealthy foods and sugar-sweetened beverages among children under five.
- To disseminate findings through awareness sessions and cooking competitions.
- Conditions
- Feeding Practices, Food Choices, Maternal and Child Health
- Keywords
- Food Choice Drivers, Food Environment, Urban Slums, India, Family, Infant Feeding
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Family or Household | Family or Households (n = 250) include all the members residing in one house sharing food and other amenities and who have children under 5 years of age. | |
| Food Vendors | Food Vendors (n = 120) who operate in the 500 m radius of the household cluster will be interviewed in depth to characterize the type of foods sold so that the food environment of the family can be characterized. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Percentage food items in each of the 28 food groups available in each of the 4 study locations
Food Availability in each study location will be assessed as the percentage food items available for purchase in each of the 28 food groups. The Food Outlet Census (https://sites.rutgers.edu/food-environment-toolbox/community-food-environment-mapping-food-outlet-census/) tool is being used to collect data on the foods available but the tool does not have any specific scoring criteria.
Measured: An average of 1 year
Percentage of families in each study location who can afford to buy a healthy diet
Food Affordability of families will be assessed as the percentage of families who can afford a healthy diet. For this purpose then investigators will calculate Cost of a Healthy Diet (CoHD) using the tool available from Tufts University: https://sites.tufts.edu/foodpricesfornutrition/tools/. Per capita income of each household will also be calculated. These two parameters will help the investigators calculate the percentage of families in each location who can afford a healthy diet.
Measured: An average of 1 Year
Percentage of food items considered convenient by households in each location
Convenience will be assessed as percentage of food items in each of the 28 food groups which participants consider convenient because their ease of storage, low perishability, ease of preparation.
Measured: An average of 1 year
Gender and Family Role of the primary food-related decision maker
The gender and family role of primary food-related decision maker will be assessed as percentages and illustrated using pie-charts
Measured: An average of 1 year
Percentage of participants concerned with food safety
Percentage of participants worried of safety of food due to poor hygiene or use of pesticides will be asessed
Measured: An average of 1 year
Percentage of households with label awareness
The percentage of households who were aware of food labeling (read labels, knew where the label was located) will be assessed
Measured: An average of 1 year
Correlation of food environment characteristics with infant and young child feeding practices
The correlation of different food environment characteristics such as accessibility, availability, affordability, with infant and young child feeding indicators such as ultra-processed food consumption, zero fruit and vegetable consumption
Measured: An average of 1 year
Secondary outcomes (2)
Number and types of food outlets in the study location
The number and types (grocery, wholesaler, specialty stores, etc) in the study location will be calculated and presented.
Measured: An average of 1 year
Type of foods being promoted in the study locations
The type of foods being promoted by roadside promotions in the study locations will be calculated.
Measured: An average of 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Aug 2025
- Study start29 Sep 2025 (estimated)
- Primary completion30 Jun 2026 (estimated)
- Study completion30 Jun 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Feeding PracticesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Family based
- Time perspective
- Cross-sectional
- Enrolment
- 370 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Hirabai Cowasji Jehangir Medical Research Institute
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Dr. Anuradha Khadilkar, Hirabai Cowasji Jehangir Medical Research Institute
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07146477
- Sponsor's protocol ID
- MCH-FEFC-2025-07
- Acronym
- FEFC
- Status last verified
- Sep 2025
- First submitted
- 16 Aug 2025
- Last updated
- 24 Sep 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided: Pseudonymized individual participant data (IPD) will be shared upon reasonable request made to the Principal Investigator only after primary study publications have been completed.
Study at a glance
From the registry record, last updated by the sponsor on 24 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- From Markets to Meals: A Mixed Methods Study on How Urban Slum Food Environments Influence Caregivers' Feeding Practices for Children Under Five Years in Pune, India
- ClinicalTrials.gov ID
- NCT07146477
- Acronym / sponsor ID
- FEFC / MCH-FEFC-2025-07
- Conditions
- Feeding Practices, Food Choices, Maternal and Child Health
- Keywords
- Food Choice Drivers, Food Environment, Urban Slums, India, Family, Infant Feeding
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 370 participants (estimated)
- Lead sponsor
- Hirabai Cowasji Jehangir Medical Research InstituteUniversity, hospital or other
- Study start
- 29 Sep 2025 (estimated)
- Primary completion
- 30 Jun 2026 (estimated)
- Study completion
- 30 Jun 2027 (estimated)
- First posted
- 28 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this observational study is to examine how urban slum food environments influence caregivers' feeding practices for children under five years of age in Pune. The main questions it aims to answer are:
- What are the characteristics of the food environment in selected slums of Pune using the 5 A's framework: availability, accessibility, affordability, acceptability, and accommodation?
- What are caregivers' perceptions of food safety, food prestige, and convenience as additional drivers of food choice within the slum context?
- Are caregivers' aware, and have understanding about the use of packaged food labels, especially in relation to identifying foods for young children?
- How do the local food environment and food choice (FEFC) drivers interact to influence caregivers' feeding practices, with a particular focus on the consumption of unhealthy foods and sugar-sweetened beverages among children under five years of age? Participants will be interviewed using digital forms to assess their food environment and food choice drivers. Anthropometric measurements of all children under five years of age in the household will be taken.
Detailed description
In India there is a high prevalence of poor complementary feeding practices. Around 1 in 2 caregivers introduced complementary foods to infants at 6-8 months, while 1 in 4 infants had the minimum dietary diversity, and 1 in 10 consumed the minimum acceptable diet. A worrisome trend being observed is the widespread consumption of ultra-processed foods (UPFs) among children across all socioeconomic groups in India. In informal settlements in Mumbai, nearly 60% children under 6 years were found to be consuming UPFs daily. Increased UPF consumption contributes significantly to the prevalence of double burden of malnutrition in India.
Pune is a rapidly growing mega-city in Maharashtra with a population of 9.4 million, which includes over 1.2 million slum-dwellers, including around 300,000 children under-five years of age. In 2020, only 6% infants had adequate diets and 12% achieved dietary diversity. Specific data is lacking on time of introduction of complementary foods and no data are available on slum-dwelling populations. The United Nations Human Settlements Program defines a slum as "a group of individuals who live under the same roof, and that lack one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living space, the durability of housing, and secure tenure". Slums are a unique and complex ecosystem where caregivers face multiple, intersecting challenges when making food choices for their children. These settings are often marked by limited infrastructure, economic constraints, and a high density of informal food vendors-conditions that may promote the availability and consumption of unhealthy foods.
The food environment defined as "consumer interface within the food system that encompasses the availability, affordability, convenience, quality and promotion, and sustainability of foods and beverages in wild, cultivated, and built spaces" is increasingly recognized as a key determinant of dietary behavior. Yet there is limited evidence from Indian slum settings on how food environments influence infant and young child feeding (IYCF) practices. Most existing research focuses on maternal knowledge or household-level factors, with minimal attention to the broader environmental and structural influences.
This study responds to this gap by assessing the 5 A's of the food environment (availability, accessibility, affordability, acceptability, and accommodation), and by exploring how these dimensions interact with caregivers' perceptions of convenience, food safety, and prestige, as well as their ability to understand and use food labels. These factors are particularly relevant in urban slums, where informal food systems dominate, and where unhealthy foods may be more readily available and aspirationally consumed. Therefore, the objectives of this study are:
- To characterize the food environment in selected slums of Pune using the 5 A's framework: availability, accessibility, affordability, acceptability, and accommodation.
- To explore caregivers' perceptions of food safety, food prestige, and convenience as additional drivers of food choice within the slum context.
- To assess caregivers' awareness, understanding, and use of packaged food labels, especially in relation to identifying foods for young children.
- To examine how the local food environment and food choice drivers interact to influence caregivers' feeding practices, with a particular focus on the consumption of unhealthy foods and sugar-sweetened beverages among children under five.
- To disseminate findings through awareness sessions and cooking competitions.
Study design
- Observational model
- Family based
- Time perspective
- Cross-sectional
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Family or Household | – | –Family or Households (n = 250) include all the members residing in one house sharing food and other amenities and who have children under 5 years of age. |
| Food Vendors | – | –Food Vendors (n = 120) who operate in the 500 m radius of the household cluster will be interviewed in depth to characterize the type of foods sold so that the food environment of the family can be characterized. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- 1. The study population will consist of Infant and young child caregivers living in slums who have a child or children less than five years of age and had enrolled in an earlier study to assess utilization of maternal healthcare services in these slums. 2. Food vendors (stores, mobile informal vendors and hawkers, and restaurants) who function in the 500 m radius of the household.
Key inclusion criteria (6 listed)
- For Family Units:
- For Food Vendors:
Key exclusion criteria (1 listed)
- 1. Families who were a part of the earlier project but have moved out of the survey area.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Percentage food items in each of the 28 food groups available in each of the 4 study locations
Time frame: An average of 1 year
Food Availability in each study location will be assessed as the percentage food items available for purchase in each of the 28 food groups. The Food Outlet Census (https://sites.rutgers.edu/food-environment-toolbox/community-food-environment-mapping-food-outlet-census/) tool is being used to collect data on the foods available but the tool does not have any specific scoring criteria.
Percentage of families in each study location who can afford to buy a healthy diet
Time frame: An average of 1 Year
Food Affordability of families will be assessed as the percentage of families who can afford a healthy diet. For this purpose then investigators will calculate Cost of a Healthy Diet (CoHD) using the tool available from Tufts University: https://sites.tufts.edu/foodpricesfornutrition/tools/. Per capita income of each household will also be calculated. These two parameters will help the investigators calculate the percentage of families in each location who can afford a healthy diet.
Percentage of food items considered convenient by households in each location
Time frame: An average of 1 year
Convenience will be assessed as percentage of food items in each of the 28 food groups which participants consider convenient because their ease of storage, low perishability, ease of preparation.
Gender and Family Role of the primary food-related decision maker
Time frame: An average of 1 year
The gender and family role of primary food-related decision maker will be assessed as percentages and illustrated using pie-charts
Percentage of participants concerned with food safety
Time frame: An average of 1 year
Percentage of participants worried of safety of food due to poor hygiene or use of pesticides will be asessed
Percentage of households with label awareness
Time frame: An average of 1 year
The percentage of households who were aware of food labeling (read labels, knew where the label was located) will be assessed
Correlation of food environment characteristics with infant and young child feeding practices
Time frame: An average of 1 year
The correlation of different food environment characteristics such as accessibility, availability, affordability, with infant and young child feeding indicators such as ultra-processed food consumption, zero fruit and vegetable consumption
2 secondary outcomes
Number and types of food outlets in the study location
Time frame: An average of 1 year
Type of foods being promoted in the study locations
Time frame: An average of 1 year
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Sep 2025.
- Individual participant dataSharing planned: Undecided. Pseudonymized individual participant data (IPD) will be shared upon reasonable request made to the Principal Investigator only after primary study publications have been completed.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Feeding Practices and Food Choices, run by Hirabai Cowasji Jehangir Medical Research Institute at 1 site in India.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 24 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Anuradha V Khadilkar (9120+26057004, anuradhavkhadilkar@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Percentage food items in each of the 28 food groups available in each of the 4 study locations (time frame: An average of 1 year). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Sep 2025.