Dietary Diversity of Young Children During CoVID-19 Outbreak: A Longitudinal Study (CoDDYC)

The 2019-2020 coronavirus pandemic has had far-reaching consequences beyond the spread of the disease. Quarantine measures during a public health pandemic can be particularly detrimental to urban poor families and affect the dietary diversity and food security. This can disproportionately affect young children aged 6 and below, and severely impact those <2 years. Sudden unemployment may result in an unexpected reduction in income that will place pressure on daily budgets for food. Children of families may not have access to foods of adequate diversity that will enable them to meet their macro and micronutrient requirements for growth and development, especially during the Movement Control Order (MCO). The study plans to monitor and evaluate dietary diversity in young children's food intake after the MCO and use the collected information to direct targeted food aid to address observed macro- and micronutrient deficiencies among the urban vulnerable group.

Study Overview

• Status: Completed
• Conditions: Dietary Diversity
• Intervention / Treatment: Other: Dietary counselling on Food Groups according to IYC Feeding practices, WHO

Detailed Description

Children are the future to our society. The first thousand days of life, starting from conception till one's second birthday is a critical period of cognitive and physical development. It is the most sensitive period where brain development is most receptive to positive nutrition. Any form of malnutrition, especially during this golden time frame, can lead to irreversible effects to growth, health, education and future career attainment to our potential leaders, which in turn can be a barrier to human development.

The CoVID outbreak is a unique period in recent human history where drastic public health measures such as MCO for an extended period of time has to be implemented nation-wide. These measures have untold severe consequences on the food security of the vulnerable urban group, in particular the young children whose brains require diverse micronutrients to support the rapid growth. These micronutrients can only be obtained from a daily diet that is equally diverse, especially from fresh vegetables and fruits which will be short in supplies. These perishable food items are not usually included in food aids, thus the child may have to subsist on staple-rich diet which are energy-dense but nutrient-poor. These dietary practices are associated with negative health outcomes. Thus by monitoring dietary diversity of the children, we hope to better inform food aid organisations to consider the inclusion of healthier food options to prevent micronutrient deficiencies.

• Study Type: Observational
• Enrollment (Actual): 469

Contacts and Locations

Study Locations

• Malaysia
  • Wilayah Persekutuan Kuala Lumpur
    • Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia, 59100
      • University of Malaya Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 months to 6 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Children who participated in the Children of Urban Poverty Iron Project (CUPIP), PPR Lembah Subang 1, Selangor

Children in PPR Kota Damansara, Selangor

Children who attend the Child Health Clinic, UMMC

Description

Inclusion Criteria:

• All well-children aged between 6 months and 6 years

Exclusion Criteria:

• Children with chronic illnesses

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Child Health Clinic (CHC); Children attending CHC for routine vaccinations and follow-up in a tertiary center Parents will be counselled on food groups based on Infant and Young Children feeding practices. Monthly telephone calls to collect data on dietary diversity - 4 telephone calls in total. Anthropometric measurements and Blood investigations for hemoglobin and iron status at the start and end of study - optional	Other: Dietary counselling on Food Groups according to IYC Feeding practices, WHO; Monitoring of Dietary diversity and growth; Other Names: Monthly telephone calls to collect data on dietary diversity - 4 telephone calls in total.; Anthropometric measurements and Blood investigations for hemoglobin and iron status (optional)
Community Children; Children of urban poor families living in low-cost flats around Kuala Lumpur. Parents will be counselled on food groups based on Infant and Young Children feeding practices. Monthly telephone calls to collect data on dietary diversity - 4 telephone calls in total. Anthropometric measurements and Blood investigations for hemoglobin and iron status at the start and end of study - optional	Other: Dietary counselling on Food Groups according to IYC Feeding practices, WHO; Monitoring of Dietary diversity and growth; Other Names: Monthly telephone calls to collect data on dietary diversity - 4 telephone calls in total.; Anthropometric measurements and Blood investigations for hemoglobin and iron status (optional)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Minimal Dietary Diversity (MDD) of more than 5 food groups in 24 hours	Number of food groups in 24 hours	24 hours
Height	Height increase in centimetres	4 months
Weight	Weight increase in kilogram	4 months
Meal frequencies in past 24 hours	Number of meal frequencies	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood hemoglobin in children at the start of study and 4 months later	Change in gram/L	4 months
Serum ferritin in children at the start of study and 4 months later	Change in microgram/L	4 months
Consumption of sugar and processed foods	Number of types	1 month
Food Aids received	Types of food groups	1 month

Collaborators and Investigators

• Sponsor: University of Malaya
• Investigators: Study Director: Mohammad Y Jalaludin, MBBS MPaeds, University of Malaya Medical Center

Publications and helpful links

General Publications

• World Health Organization. Indicators for assessing infant and young child feeding practices Part 1: Definitions. Geneva: WHO; 2008
• Working Group on Infant and Young Child Feeding Indicators. Developing and validating simple indicators of dietary quality of infants and young children in developing countries: Additional analysis of 10 data sets. Report submitted to: the Food and Nutrition Technical Assistance (FANTA) Project/Academy for Educational Development (AED), July 2007
• Kennedy GL, Pedro MR, Seghieri C, Nantel G, Brouwer I. Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children. J Nutr. 2007 Feb;137(2):472-7. doi: 10.1093/jn/137.2.472.
• Cusick SE, Georgieff MK. The Role of Nutrition in Brain Development: The Golden Opportunity of the "First 1000 Days". J Pediatr. 2016 Aug;175:16-21. doi: 10.1016/j.jpeds.2016.05.013. Epub 2016 Jun 3. No abstract available.
• Steyn NP, Nel JH, Nantel G, Kennedy G, Labadarios D. Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy? Public Health Nutr. 2006 Aug;9(5):644-50. doi: 10.1079/phn2005912.
• World Health Organization, Geneva. 2017; Global Nutritional Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025

Study record dates

Study Major Dates

• Study Start (Actual): June 6, 2020
• Primary Completion (Actual): December 31, 2021
• Study Completion (Actual): March 31, 2022

Study Registration Dates

• First Submitted: June 17, 2020
• First Submitted That Met QC Criteria: June 23, 2020
• First Posted (Actual): June 25, 2020

Study Record Updates

• Last Update Posted (Actual): November 2, 2022
• Last Update Submitted That Met QC Criteria: October 31, 2022
• Last Verified: October 1, 2022

More Information

Terms related to this study

• Keywords: young children; Dietary diversity; micro-nutrient adequacy; urban settings
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Peripheral Nervous System Agents; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Chrysarobin
• Other Study ID Numbers: 2020410-8500

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: We will share demographic data of subject and family, baseline anthropometric measurements as well as dietary diversity of children in various locales

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No