Study protocol to assess the impact of an integrated nutrition intervention on the growth and development of children under two in rural Bangladesh

Gulshan Ara, Kazi Istiaque Sanin, Mansura Khanam, Shafiqul Alam Sarker, Sihan Sadat Khan, Mahfuza Rifat, Imran Ahmed Chowdhury, Sufia Askari, Kaosar Afsana, Tahmeed Ahmed, Gulshan Ara, Kazi Istiaque Sanin, Mansura Khanam, Shafiqul Alam Sarker, Sihan Sadat Khan, Mahfuza Rifat, Imran Ahmed Chowdhury, Sufia Askari, Kaosar Afsana, Tahmeed Ahmed

Abstract

Background: The period from birth to two years is the "critical window" for achieving optimal growth and development. An inadequate quality and quantities of complementary foods, poor child-feeding practices and infection negatively impact the growth of under-twos. Approximately one-third of under-fives in developing countries are stunted; many are also micronutrient deficient. An estimated 6% of mortalities among under-fives can be prevented by ensuring optimal complementary feeding. The objective of the study was to assess the ability of a 12-month integrated nutrition intervention to improve the nutritional status (length-for-age Z-score) of 6 to 12-month-old children in rural Bangladesh.

Methods: In this community-based randomized controlled trial, the intervention group received a package of interventions that includes, food vouchers; to prepare egg-based nutritious snacks (suji firni for < 1-year-olds, suji halwa for > 1-year-olds), micronutrient powder to fortify children's food at home, child feeding counselling and water, sanitation and hygiene (WASH), behaviour change communication. The control group received routine health messages provided by the government. Baseline and endline surveys were conducted; Data collection was performed monthly on children's growth, food voucher utilization, child feeding and morbidity. In addition, we assessed the cognitive development of the children after 12 months of intervention.

Conclusion: This trial aims to explore whether an integrated nutrition intervention can mitigate childhood stunting during the critical window of opportunity in rural Bangladesh. The results may provide robust evidence to improve the linear growth of children in developing countries.

Trial registration: The study was retrospectively registered on August 17, 2018 and is available online at ClinicalTrials.gov (ID: NCT02768181).

Keywords: Cognitive development; Complementary food; Intervention; Length-for-age Z-score; Nutrition; Stunting.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
Study flow chart

References

    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–451.
    1. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–357.
    1. UNICEF, WHO, World Bank. Levels and trends in child malnutrition: joint child malnutrition estimates. 2012.
    1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360(9343):1347–1360.
    1. Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, et al. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS Med. 2016;13(11):e1002164.
    1. Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal and child nutrition. 2008;4:24–85.
    1. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Group BCSS How many child deaths can we prevent this year? Lancet. 2003;362(9377):65–71.
    1. Onyango AW, Borghi E, de Onis M, del Carmen CM, Garza C. Complementary feeding and attained linear growth among 6–23-month-old children. Public Health Nutr. 2014;17(9):1975–1983.
    1. World Health Organization. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. 2009.
    1. World Health Organization. Indicators for assessing infant and young child feeding practices: part 1: definitions: conclusions of a consensus meeting held 6–8 November 2007 in Washington DC, USA. 2008.
    1. Daelmans B, Mangasaryan N, Martines J, Saadeh R, Casanovas C, Arabi M. Strengthening actions to improve feeding of infants and young children 6 to 23 months of age: summary of a recent World Health Organization/UNICEF technical meeting, Geneva, 6–9 October 2008. Food and nutrition bulletin. 2009;30(2_suppl2):S236-S8.
    1. Piwoz E, Sundberg S, Rooke J. Promoting healthy growth: what are the priorities for research and action? Adv Nutr. 2012;3(2):234–241.
    1. Arimond M, Ruel MT. Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr. 2004;134(10):2579–2585.
    1. Onyango A, Koski KG, Tucker KL. Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. Int J Epidemiol. 1998;27(3):484–489.
    1. Bwibo NO, Neumann CG. The need for animal source foods by Kenyan children. J Nutr. 2003;133(11):3936S–3940S.
    1. Krebs NF. Food choices to meet nutritional needs of breast-fed infants and toddlers on mixed diets. J Nutr. 2007;137(2):511S–517S.
    1. Marquis GS, Habicht J-P, Lanata CF, Black RE, Rasmussen KM. Breast milk or animal-product foods improve linear growth of Peruvian toddlers consuming marginal diets. Am J Clin Nutr. 1997;66(5):1102–1109.
    1. Lutter CK, Mora JO, Habicht J-P, Rasmussen KM, Robson DS, Herrera MG. Age-specific responsiveness of weight and length to nutritional supplementation. Am J Clin Nutr. 1990;51(3):359–364.
    1. Schroeder DG, Martorell R, Rivera JA, Ruel MT, Habicht J-P. Age differences in the impact of nutritional supplementation on growth. The Journal of nutrition. 1995;125(suppl_4):1051S–9S.
    1. National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International. , 2016.
    1. Kimmons JE, Dewey KG, Haque E, Chakraborty J, Osendarp SJ, Brown KH. Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr. 2005;135(3):444–451.
    1. Saha KK, Frongillo EA, Alam DS, Arifeen SE, Persson LA, Rasmussen KM. Household food security is associated with infant feeding practices in rural Bangladesh. J Nutr. 2008;138(7):1383–1390.
    1. Faruque ASG, Ahmed AS, Ahmed T, Islam MM, Hossain MI, Roy S, et al. Nutrition: basis for healthy children and mothers in Bangladesh. Journal of health, population, and nutrition. 2008;26(3):325.
    1. Ahmed T, Mahfuz M, Ireen S, Ahmed AS, Rahman S, Islam MM, et al. Nutrition of children and women in Bangladesh: trends and directions for the future. Journal of health, population, and nutrition. 2012;30(1):1.
    1. Zongrone A, Winskell K, Menon P. Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data. Public Health Nutr. 2012;15(9):1697–1704.
    1. Headey DD, Alderman HH. The relative caloric prices of healthy and unhealthy foods differ systematically across income levels and continents. J Nutr. 2019.
    1. Paes-Sousa R, Santos LMP, Miazaki ÉS. Effects of a conditional cash transfer programme on child nutrition in Brazil. Bull World Health Organ. 2011;89(7):496–503.
    1. Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low-and middle-income countries: a systematic review. Jama. 2007;298(16):1900–1910.
    1. Institute IFPR. Transfer Modality Research Initiative (TMRI) Washington, DC 20005–3915 USA. Available from: .
    1. de Romana DL, Salazar M, Hambidge KM, Penny ME, Peerson JM, Krebs NF, et al. Longitudinal measurements of zinc absorption in Peruvian children consuming wheat products fortified with iron only or iron and 1 of 2 amounts of zinc. Am J Clin Nutr. 2005;81(3):637–647.
    1. Cohen J. Statistical power analysis for the behavioral sciences: Routledge; 2013.
    1. Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson J, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. Bmj. 2012;344:e2088.
    1. Management of severe acute malnutrition in infants and children. Available from: .
    1. Foundation BB. Guidelines for complementary feeding Bangladesh 2014. Available from: .
    1. Cogill B. Anthropometric indicators measurement guide. 2003.
    1. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: A Division of Human Kinetics Publishers; 1991.
    1. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. 2006.
    1. National Institute of Population Research and Training (NIPORT), Mitra and Associates, Macro. O. Bangladesh Demographic and Health Survey 2004. Dhaka, Bangladesh and Calverton, Maryland [USA]: National Institute of population research and training, Mitra and Associates, and ORC Macro, 2005.
    1. Organization WH. Indicators for assessing infant and young child feeding practices: part 2: measurement. 2010.
    1. Jennifer Coates AS, Paula Bilinsky. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide August 2007.
    1. Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med. 2011;8(6):e1001052.
    1. Bayley N. Bayley scales of infant development (Bsid-II) San Antonio, TX: Psychological Corporation; 1993.
    1. Hamadani JD, Mehrin SF, Tofail F, Hasan MI, Huda SN, Baker-Henningham H, et al. Integrating an early childhood development programme into Bangladeshi primary health-care services: an open-label, cluster-randomised controlled trial. Lancet Glob Health. 2019;7(3):e366–ee75.
    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–260.
    1. Mennella JA, Trabulsi JC. Complementary foods and flavor experiences: setting the foundation. Ann Nutr Metab. 2012;60(Suppl. 2):40–50.
    1. Zaman S, Ashraf RN, Martines J. Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: a cluster-randomized controlled trial in Lahore, Pakistan. Journal of health, population, and nutrition. 2008;26(2):210.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe