Kathryn G Dewey1, Malay K Mridha2,3, Susana L Matias2, Charles D Arnold2, Joseph R Cummins4, Md Showkat Ali Khan5, Zeina Maalouf-Manasseh6, Zakia Siddiqui3, Md Barkat Ullah2, Stephen A Vosti7. 1. Departments of Nutrition and kgdewey@ucdavis.edu. 2. Departments of Nutrition and. 3. Nutrition and Clinical Science Division and. 4. Department of Economics, University of California, Riverside, CA. 5. Initiative of Noncommunicable Disease, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh; and. 6. Food and Nutrition Technical Assistance III Project (FANTA)/FHI 360, Washington, DC. 7. Agricultural and Resource Economics, University of California, Davis, CA.
Abstract
Background: Stunting in linear growth occurs mainly during the first 1000 d, from conception through 24 mo of age. Despite the recognition of this critical period, there have been few evaluations of the growth impact of interventions that cover most of this window.Objective: We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program. We hypothesized that small-quantity lipid-based nutrient supplements (LNSs) provided to women during pregnancy and the first 6 mo postpartum, LNSs provided to their offspring from 6 to 24 mo of age, or both would result in greater child length-for-age z score (LAZ) at 24 mo than iron and folic acid (IFA) provided to women during pregnancy and postpartum plus micronutrient powder (MNP) or no supplementation for their offspring from 6 to 24 mo.Design: We conducted a cluster-randomized effectiveness trial with 4 arms: 1) women and children both received LNSs (LNS-LNS group), 2) women received IFA and children received LNSs (IFA-LNSgroup), 3) women received IFA and children received MNP (IFA-MNPgroup), and 4) women received IFA and children received no supplements (IFA-Control group). We enrolled 4011 women at ≤20 wk of gestation within 64 clusters, each comprising the supervision area of a community health worker. Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer-corrected pairwise comparisons. Results: At 24 mo, the LNS-LNS group had significantly higher LAZ (+0.13 compared with the IFA-MNP group) and head circumference (+0.15 z score compared with the IFA-Control group); these outcomes did not differ between the other groups. Stunting prevalence (LAZ <-2) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group (OR: 0.70; 95% CI: 0.53, 0.92), but the difference diminished by 24 mo (OR: 0.81; 95% CI: 0.63, 1.04). Conclusion: Home fortification with small-quantity LNSs, but not MNP, during the first 1000 d improved child linear growth and head size in rural Bangladesh. This trial was registered at clinicaltrials.gov as NCT01715038.
RCT Entities:
Background: Stunting in linear growth occurs mainly during the first 1000 d, from conception through 24 mo of age. Despite the recognition of this critical period, there have been few evaluations of the growth impact of interventions that cover most of this window.Objective: We evaluated home fortification approaches for preventing maternal and child undernutrition within a community-based health program. We hypothesized that small-quantity lipid-based nutrient supplements (LNSs) provided to women during pregnancy and the first 6 mo postpartum, LNSs provided to their offspring from 6 to 24 mo of age, or both would result in greater child length-for-age z score (LAZ) at 24 mo than iron and folic acid (IFA) provided to women during pregnancy and postpartum plus micronutrient powder (MNP) or no supplementation for their offspring from 6 to 24 mo.Design: We conducted a cluster-randomized effectiveness trial with 4 arms: 1) women and children both received LNSs (LNS-LNS group), 2) women received IFA and children received LNSs (IFA-LNS group), 3) women received IFA and children received MNP (IFA-MNP group), and 4) women received IFA and children received no supplements (IFA-Control group). We enrolled 4011 women at ≤20 wk of gestation within 64 clusters, each comprising the supervision area of a community health worker. Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer-corrected pairwise comparisons. Results: At 24 mo, the LNS-LNS group had significantly higher LAZ (+0.13 compared with the IFA-MNP group) and head circumference (+0.15 z score compared with the IFA-Control group); these outcomes did not differ between the other groups. Stunting prevalence (LAZ <-2) was lower in the LNS-LNS group at 18 mo than in the IFA-MNP group (OR: 0.70; 95% CI: 0.53, 0.92), but the difference diminished by 24 mo (OR: 0.81; 95% CI: 0.63, 1.04). Conclusion: Home fortification with small-quantity LNSs, but not MNP, during the first 1000 d improved child linear growth and head size in rural Bangladesh. This trial was registered at clinicaltrials.gov as NCT01715038.
Authors: Jai K Das; Rehana A Salam; Yousaf Bashir Hadi; Sana Sadiq Sheikh; Afsah Z Bhutta; Zita Weise Prinzo; Zulfiqar A Bhutta Journal: Cochrane Database Syst Rev Date: 2019-05-02
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Authors: Kendra Byrd; Holly N Dentz; Anne Williams; Marion Kiprotich; Amy J Pickering; Ronald Omondi; Osborne Kwena; Gouthami Rao; Charles D Arnold; Benjamin F Arnold; Kathryn G Dewey; John M Colford; Clair Null; Christine P Stewart Journal: Matern Child Nutr Date: 2018-09-12 Impact factor: 3.092
Authors: Parminder S Suchdev; Maria Elena D Jefferds; Erika Ota; Katharina da Silva Lopes; Luz Maria De-Regil Journal: Cochrane Database Syst Rev Date: 2020-02-28
Authors: Nancy F Krebs; K Michael Hambidge; Jamie L Westcott; Ana L Garcés; Lester Figueroa; Antoinette K Tsefu; Adrien L Lokangaka; Shivaprasad S Goudar; Sangappa M Dhaded; Sarah Saleem; Sumera Aziz Ali; Carl L Bose; Richard J Derman; Robert L Goldenberg; Vanessa R Thorsten; Amaanti Sridhar; Dhuly Chowdhury; Abhik Das Journal: J Pediatr Date: 2020-09-18 Impact factor: 4.406