evidence-based blog of Filippo Dibari

Posts Tagged ‘stunting’

Evidence of Effective Approaches to SBCC for Preventing and Reducing Stunting and Anemia

In Under-nutrition on October 27, 2014 at 3:28 pm

From Spring web page

(download the doc)

Evidence suggests that simply increasing knowledge and awareness of good nutrition practices rarely leads to sustained behavior change, nor is sustained change in nutrition behavior likely to be achieved through a single activity. Several specific behaviors or practices impact nutritional status during the critical first 1,000 days (pregnancy to age two), while complex, contextual determinants also influence individual decisions to consider, test, adopt and sustain a given behavior or practice. The field of Social and Behavior Change Communication (SBCC) is a collection of approaches and tools informed by behavioral theories and used to design public health interventions.

This review, part of a broader effort by SPRING to support governments and other stakeholders in their delivery of high impact nutrition practices, provides a summary of peer-reviewed evidence regarding the effectiveness of SBCC approaches to increase the uptake of three key nutrition behaviors: women’s dietary practices during pregnancy and lactation, breastfeeding practices, and complementary feeding practices. SBCC interventions have been broadly categorized into three areas: interpersonal communication; use of media; and community/social mobilization. This review also identifies gaps in the evidence and recommendations for further areas of study.

This review includes a total of 91 studies identified using the Ovid MEDLINE database. Recognizing the potential value of a broad array of study designs, results from five study types are included: reviews (including meta-analysis), randomized controlled trials, longitudinal studies, repeated cross-sectional studies, and cross-sectional studies. Excluded studies include those with data from high income countries, those published prior to 2000, those written in a language other than English, and those that focused exclusively on refinement of a research methodology. Other exclusions are noted in the text.

Each of the following sections contain interactive tables featuring the articles reviewed for this study.

Findings related to women’s dietary practices during pregnancy and lactation

Undernutrition during pregnancy and lactation is a critical determinant of maternal, neonatal, and child health outcomes. Improving dietary adequacy during pregnancy and lactation is important to help women accommodate their nutritional requirements as well as their children’s requirements during intrauterine development and while breastfeeding (Haileslassie, et al., 2013).

The body of literature on the effectiveness of SBCC to improve women’s dietary practices during pregnancy and lactation is still small (only 15 peer-reviewed studies met the inclusion criteria), but indicates that SBCC approaches can and do succeed in improving uptake of the behaviors promoted. The greatest gap in the literature was in evidence of effectiveness of SBCC in improving rest and workload during pregnancy. Given the importance of women’s dietary practices during pregnancy and lactation, the dearth of evidence is notable.

Browse this section’s interactive table of articles

Findings related to breastfeeding practices

Breastfeeding is widely recognized as one of the most costeffective investments to improve child survival (UNICEF, 2013), as well as cognitive and motor development and academic performance (Horta et al, 2013). Breastfeeding also imparts critical benefits to the woman, including natural postnatal infertility. Despite the promise of optimal breastfeeding practices, rates for WHO recommended breastfeeding practices remain low (UNICEF, 2013).

The body of literature on the effectiveness of SBCC approaches in improving breastfeeding practices is strong and broad (62 peer-reviewed studies met the inclusion criteria) and supports the claim that SBCC approaches can and do succeed in improving uptake of the behaviors promoted.

Evidence from several studies strongly suggests that increasing the number of contacts increases the positive effect of SBCC on breastfeeding practices. Greater consistency in how breastfeeding practices are measured – the definitions of indicators and the methods of data collection – exists for breastfeeding practices when compared to women’s dietary practices and complementary feeding practices, but even with globally-recognized indicators and measurement guidance, considerable variation remains.

Browse this section’s interactive table of articles

Findings related to complementary feeding practices

Timely appropriate complementary feeding are critical to a child’s growth and development and could avert millions of disability-adjusted life years, but global coverage of optimal complementary feeding practices remains low.

The evidence of the effect of SBCC on complementary feeding practices is quite broad (30 studies met the inclusion criteria) and clearly indicates that SBCC interventions can improve a wide range of complementary feeding practices. However, measures of optimal complementary feeding are so varied that it is particularly challenging to draw conclusions regarding the effectiveness of particular SBCC approaches.

Browse this section’s interactive table of articles

Common findings

The SBCC approach most used, and the only one used without other communication interventions, was interpersonal communication. While media and community/ social mobilization were used, they were always used with at least one other communication approach.

Studies included in this review employed a wide range of implementation strategies with variations in the interactions or combinations with other interventions, target groups, content, messages, scale and coverage, length and intensity, as well as context. Very little has been done to compare the effect of differences in the delivery science, particularly when implemented at scale.

The majority of the studies were implemented on a small scale, typically with fewer than 500 people per group.

Additionally, there was considerable variation in how women’s dietary practices and complementary feeding practices were defined and measured.

Conclusions

Evidence suggests that using multiple SBCC approaches and channels to change behaviors is more effective than using one, that targeting multiple contacts has a greater effect than targeting only the woman herself, and that more visits or contacts results in greater change. However, such comparisons are not well-tested in the literature. Very few comparisons have been made between the effect of timing of communications and what little has been done presents contradictory evidence. Unfortunately, it can be challenging to conduct such studies that compare differences in delivery and/or disaggregate single approaches within a multiapproach intervention. SBCC practitioners and researchers must assess whether that line of research is useful.

Differences in local context (including social norms, culture, and environmental factors) as well as differences in the implementation and scale of implementation also affect the success of interventions. This underscores the importance of proper context assessments, formative research and/or ethnographic study prior to SBCC implementation.

Finally, if practices and indicators are not standardized, a project may improve behaviors but it will be difficult to attribute changes in outcomes. This underscores the importance of developing practices and indicators that are globally recognized, accepted, and used by the research and program communities. At the same time, many nutrition interventions are suited to iterative programming for incremental change toward the optimal, evidence-based behaviors. This means that more easily achieved indicators (components of standardized indicators or shorter time periods) may also be needed to measure progress toward the ultimate goal of changes in the standardized indicators of behaviors.

Other areas particularly important for future evaluations and operations research include:

  • the effect of targeting multiple audiences or influencers of the behaviors being promoted, rather than focusing on one target population;
  • the effect of the same SBCC intervention implemented in different contexts (social and environmental);
  • the effectiveness of different approaches (including intensity and targeting) for different behaviors;
  • the cost and cost effectiveness of various SBCC approaches (particularly as it relates to scalability); and
  • the effectiveness and sustainability of these approaches when implemented at scale.

School Feeding: Can stunting be reversed? Yes, and Peru is showing us how

In Under-nutrition on October 27, 2014 at 7:59 am

From the web site of Schools & Health.

 

Children affected by the 2008 food crisis in Peru show stunting can be reversed. Is it time to focus beyond the first 1,000 days?

In 2008 there was a terrible food crisis in Peru. The price o​f rice doubled in three months and millions of families were struggling to put food on the table. Six years on, thousands of Peruvian children who were babies and toddlers during the food crisis are much smaller than they should be. And for many, their cognitive skills development has been negatively affected too.

Children’s bodies and brains develop fastest when they’re in the womb and during the first two years of their lives: the first thousand days. And it’s during this crucial period that physical stunting and cognitive impairment can really set in if pregnant mothers and babies miss out on adequate nutrition.

Research has suggested that early stunting and its effects are irreversible. So will these Peruvian children’s futures be permanently blighted because they weren’t getting enough to eat when they were little?

At Young Lives we’ve been studying the progress of 12,000 children in Peru, Vietnam, Ethiopia, and India – measuring all aspects of their physical, cognitive, and social development since 2002. We’ve been following the development of children who were undernourished early in their lives and we’ve discovered that the effects of early undernutrition aren’t always irreversible. Some children in our studies were able to recover from early stunting and develop normally.

In particular, our results show that around 50% of children in Peru who were stunted in 2002, when they were around a year old, were not stunted in 2009. The same figure was around 45% for India.

So while the first thousand days are very important, the rest of a child’s life is too. It now seems clear that children can recover from stunting after their first thousand days.

Our findings indicate that factors like household income, maternal education and health, local water, sanitation and health infrastructure, which are key to stunting prevention, are also important for recovery from stunting.

Recovery from stunting after the first thousand days may also lead to the reversal of developmental setbacks such as cognitive impairment. Our findings suggest that children who recovered from early stunting performed better in vocabulary and mathematics tests than children who remained stunted.

School meals, cash transfer and health programmes can help

This and other evidence suggests that school feeding programmes may help undernourished children to recover from stunting. Young Lives fin​dings show that India’s national school feeding programme helped children to recover from a decline in growth due to a severe drought when they were one-year-old. In Peru, national feeding programmes, such as Qali Warma and Vaso de Leche may have helped children who became stunted as a result of the food crisis to recover.

Conditional cash transfer programmes that provide financial incentives to poor households to invest in children’s health may also be a powerful instrument in the fight against child undernutrition​. An example of such a programme in Peru is Juntos, which requires that children below the age of five in families that receive the support, must attend health facilities for comprehensive healthcare and nutrition.

To prevent stunting, there are potential benefits to extending the coverage of early child development programmes to older children. For example, Cuna Mas in Peru, which aims to improve development for children living in poverty, could be extended from children younger than three to children younger than six-years-old.

There’s no doubt about the importance of the first thousand days for a child’s growth and development, so nutrition intervention needs to start early. But intervention shouldn’t always end when the child reaches two. It needs to be sustained throughout childhood and target the most stunted and undernourished children so they have a decent chance to recover.​

The Making of a Messenger: Engaging Extension and Advisory Service Providers in Nutrition-Sensitive Agriculture | SPRING

In Under-nutrition on October 19, 2014 at 6:54 am

Date(s):  October 29, 2014 – from USAID web site

Agriculture extension agents are a valuable source of information and expertise for many small scale farmers across the globe. As global understanding builds around the linkages between agriculture and nutrition, efforts are currently underway to integrate activities promoting nutrition into agriculture extension programming in several Feed the Future countries. Join SPRING and the Modernizing Extension and Advisory Services (MEAS) project in a two-part webinar series exploring these efforts in Malawi and Ethiopia.

The first event, scheduled for October 29th at 9:00 a.m. EST, will focus on MEAS’s assessment of agricultural extension, nutrition education, and integrated agriculture-nutrition programs and systems in Malawi. The assessment aims to inform the design of an activity that will strengthen delivery of coordinated and integrated extension and nutrition outreach services in Malawi’s Feed the Future focus districts. Vickie Sigman, Independent Senior Agriculture Extension Specialist, will discuss the various programs and systems in place in Malawi to deliver integrated extension and nutrition outreach services. Service delivery constraints and possibilities for addressing existing constraints will aslo be highlighted. Paul McNamara, Director, Modernizing Extension and Advisory Services Project and Valerie Rhoe, Senior Technical Advisor at Catholic Relief Services, will serve as respondents as part of the presentation.

The second event is scheduled for November 13th at 9:00 a.m. EST and will examine SPRING’s recent work in Ethiopia. SPRING collaborated with the USAID Mission and several Feed the Future implementing partners  to document the experiences and coordination among Feed the Future partners utilizing public extension agriculture Development Agents (DAs) to deliver nutrition messages and interventions at the community-level. SPRING’s Social and Behavior Change Advisor, Ashley Aakesson, will discuss the processes, challenges, successes, and lessons learned from project staff, government staff including DAs, and community members, and ways current programming and coordination could be adjusted to improve nutrition outcomes.

CGIAR: Call for concept notes: nutrition-relevant policy and action in eastern Africa

In Under-nutrition on October 7, 2014 at 7:37 am

from CGIAR web pageOctober 3, 2014 by

The Transform Nutrition Research Consortium, a network which seeks to transform thinking and action on nutrition among research, operational, and policy communities in South Asia and eastern Africa, invites proposals for studies of up to 24 months duration which will add to the evidence base on nutrition-relevant policy and action in eastern Africa.

 

The challenge

Nutrition is foundational to the achievement of major social and economic goals, including many international development goals. Undernutrition in early life is responsible for 45% of under-five child deaths, reduced cognitive attainment, increased likelihood of poverty and is associated with increased maternal morbidity and mortality.

 

Child stunting rates in eastern Africa are among the highest in the world. The four countries in this call (Kenya, Ethiopia, Uganda and Tanzania) are home to around 13 million stunted children, and among the highest burden countries in the world. Ensuring food and nutrition security in the region can only occur through a combination of targeted “nutrition-specific” interventions and wider “nutrition-sensitive” development interventions, backed up by enabling policy, political and institutional environments, and processes. Political commitment to address undernutrition is growing in the region (all four countries, for example, have signed up to the SUN Movement) and nutrition policies and action plans are being drawn up or revised.

 

While progress is being made, much more can be done. Scoping work within both Transform Nutrition and A4NH have clearly revealed major operational and policy-related knowledge gaps that broadly relate to the thematic focus of this call. This call for concept notes is thus intended to help fill these knowledge gaps, through locally-relevant research undertaken by research organizations from the region.

 

Click here to download the Call for Research Concept Notes.

 

This call seeks to engender a wider sense of engagement in nutrition-relevant research among national and regional stakeholders in four countries of eastern Africa: Kenya, Ethiopia, Uganda and Tanzania. We seek high quality research proposals on at least one of the following research themes:

 

Theme 1: How can nutrition-specific interventions be appropriately prioritized, implemented, scaled up, and sustained in different settings?

Theme 2: How can agriculture and the wider agri-food systems become more nutrition-sensitive and have a greater impact on nutrition outcomes?

Theme 3: How can enabling (policy and institutional) environments for nutrition be cultivated and sustained?

 

Cross-cutting issues include: governance, inclusion (socio-economic and gender equity) and fragility. Gendered approaches are especially important for proposals under Theme 2.

 

Eligibility criteria and important considerations:

  • Applicants are encouraged to familiarize themselves with work underway or completed by Transform and A4NH (accessible via websites above) to maximize “value added” and complementarity with ongoing work, and avoid duplication.
  • Applicant organisations must be legally registered entities in one of the four focal countries, capable of receiving and managing funds.
  • Joint applications by more than one organization are encouraged, but one local organization must be specified as the lead.
  • An organisation may submit more than one application, and an individual may be involved in multiple proposals, but any individual may be the lead researcher on only one application.
  • Partner organizations within Transform Nutrition or A4NH may collaborate in proposed studies, but they are exempt from leading the call, and funds for their participation will need to be separately sourced.
  • Research studies may be of 6-24 months duration.
  • The requested budget for each study should lie in the range: $50,000 – $150,000. Studies that are more expensive may be considered so long as there is guaranteed co-funding to meet requirements beyond this range.
  • Each of the three themes has its own budget ceiling of $150,000.
  • It is expected that 3-6 studies (in total) will be funded through this call, with at least one study from each theme.

 

Evaluation criteria

  • quality of the concept note and proposed research
  • relevance and “value added” with regard to Transform and A4NH’s work
  • value for money
  • internal capacity (for high quality research and efficient project management)
  • clearly specified policy relevance and potential for impact

 

Format of concept notes

Please submit a concept note of no more than 3 pages (single-spaced) that clearly states:

  • problem statement (including which theme(s) the project responds to),
  • context (including what is known already),
  • objectives and research questions,
  • study design and methods to be used,
  • expected outputs, outcomes and impact,
  • lead researcher, core research team and partners (CVs not required at this stage)
  • timeframe,
  • indicative budget (with breakdowns of personnel, travel and other expenses.)

No additional material will be considered.

 

Review and selection process

The following process will be adopted:

  1. Applicant organizations are invited (through this call) to respond by 21 November 2014, and according to specified eligibility and evaluation criteria, and format, with a concept note.
  2. Concept notes will be screened against these criteria and quality filters by a review team comprising members of TN and A4NH, to select a shortlist.
  3. Shortlisted applicants will be invited to prepare detailed research proposals (by 15 January 2015)
  4. These proposals will again be reviewed by the review panel, using a standard scoring system before 30 January 2015.
  5. The winning research proposals will then be announced.
  6. Contracts will be agreed with lead organizations in February 2015.
  7. Studies will start no later than 1 March 2015.

 

Concept notes should be emailed to Sivan Yosef (IFPRI) at s.yosef@cgiar.org

All queries concerning this call should be addressed to Catherine Gee at c.gee@cgiar.org

 

*Final deadline for concept notes is 21 November 2014, (23:59 GMT).

Maternal and Child Nutrition: Promoting Healthy Growth and Preventing Childhood Stunting

In Under-nutrition on September 14, 2014 at 6:06 am

Maternal and Child Nutrition Journal – Special Issue: Promoting Healthy Growth and Preventing Childhood Stunting

September 2013 – Volume 9, Issue Supplement S2 Pages 1–149

  • Editorial

You have free access to this content

Promoting healthy growth and preventing childhood stunting: a global challenge (pages 1–5)

Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12092

  • Original Article

You have free access to this content

The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions (pages 6–26)

Mercedes de Onis, Kathryn G. Dewey, Elaine Borghi, Adelheid W. Onyango, Monika Blössner, Bernadette Daelmans, Ellen Piwoz and Francesco Branca

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12075

You have free access to this content

Contextualising complementary feeding in a broader framework for stunting prevention (pages 27–45)

Christine P. Stewart, Lora Iannotti, Kathryn G. Dewey, Kim F. Michaelsen and Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12088

  • Review Article

You have free access to this content

Multi-sectoral interventions for healthy growth (pages 46–57)

Ma del Carmen Casanovas, Chessa K. Lutter, Nune Mangasaryan, Robert Mwadime, Nemat Hajeebhoy, Ana Maria Aguilar, Ciro Kopp, Luis Rico, Gonzalo Ibiett, Doris Andia and Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12082

  • Original Articles

You have free access to this content

Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study (pages 58–68)

Cutberto Garza, Elaine Borghi, Adelheid W. Onyango, Mercedes de Onis and WHO Multicentre Growth Reference Study Group

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12085

You have free access to this content

The economic rationale for investing in stunting reduction (pages 69–82)

John Hoddinott, Harold Alderman, Jere R. Behrman, Lawrence Haddad and Susan Horton

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12080

You have free access to this content

The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction (pages 83–100)

David Pelletier, Rukhsana Haider, Nemat Hajeebhoy, Nune Mangasaryan, Robert Mwadime and Satyajit Sarkar

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12081

You have free access to this content

Key principles to improve programmes and interventions in complementary feeding (pages 101–115)

Chessa K Lutter, Lora Iannotti, Hilary Creed-Kanashiro, Agnes Guyon, Bernadette Daelmans, Rebecca Robert and Rukhsana Haider

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12087

You have free access to this content

Designing appropriate complementary feeding recommendations: tools for programmatic action (pages 116–130)

Bernadette Daelmans, Elaine Ferguson, Chessa K. Lutter, Neha Singh, Helena Pachón, Hilary Creed-Kanashiro, Monica Woldt, Nuné Mangasaryan, Edith Cheung, Roger Mir, Rossina Pareja and André Briend

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12083

You have free access to this content

Introducing infant and young child feeding indicators into national nutrition surveillance systems: lessons from Vietnam (pages 131–149)

Nemat Hajeebhoy, Phuong Hong Nguyen, Do Thanh Tran and Mercedes de Onis

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12086

- – -
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

The economic rationale for investing in stunting reduction

In Under-nutrition on June 25, 2014 at 6:51 am

by John Hoddinott, Harold Alderman, Jere R. Behrman, Lawrence Haddad, and Susan Horton.

Maternal & Child Nutrition. Special Issue: Promoting Healthy Growth and Preventing Childhood Stunting. Volume 9, Issue Supplement S2, pages 69–82, September 2013

(download)

 

Abstract

This paper outlines the economic rationale for investments that reduce stunting.

We present a framework that illustrates the functional consequences of stunting in the 1000 days after conception throughout the life cycle: from childhood through to old age. We summarize the key empirical literature around each of the links in the life cycle, highlighting gaps in knowledge where they exist. We construct credible estimates of benefit–cost ratios for a plausible set of nutritional interventions to reduce stunting.There are considerable challenges in doing so that we document.

We assume an uplift in income of 11% due to the prevention of one fifth of stunting and a 5% discount rate of future benefit streams.

Our estimates of the country-specific benefit-cost ratios for investments that reduce stunting in 17 high-burden countries range from 3.6 (DRC) to 48 (Indonesia) with a median value of 18 (Bangladesh). Mindful that these results hinge on a number of assumptions, they compare favourably with other investments for which public funds compete.

The nutritional value of toilets: How much international variation in child height can sanitation explain?

In Under-nutrition on May 4, 2014 at 7:39 am

by Dean Spears (World Bank). From the Rice Web Site – June 2013

(download the entire doc)

Abstract

Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. In particular, children in India are shorter, on average, than children in Africa who are poorer, on average, a paradox called \the Asian enigma” which has received much attention from economists.

 Could toilets help children grow tall, while disease externalities from poor sanitation keep children from reaching their height potentials? This paper provides the first identification of a quantitatively important gradient between child height and sanitation, which can statistically explain a large fraction of international height differences.

I apply three complementary empirical strategies to identify the association between sanitation and child height: country-level regressions across 140 country-years in 65 developing countries; within-country analysis of differences over time within Indian districts; and econometric decomposition of the India-Africa height difference in child level data.

 The effect of sanitation on human capital is quantitatively robustly estimated across these strategies, and does not merely reflect wealth or other dimensions of development. Open defecation, which is exceptionally widespread in India, can account for much or all of the excess stunting in India.

The use of linear programming to determine whether a formulated complementary food product can ensure adequate nutrients for 6- to 11-month-old Cambodian infants

In Under-nutrition on February 5, 2014 at 11:46 am

Jutta KH Skau, Touch Bunthang, Chhoun Chamnan, Frank T Wieringa, Marjoleine A Dijkhuizen, Nanna Roos, and Elaine L Ferguson

Am J Clin Nutr January 2014 vol. 99 no. 1 130-138

Abstract

Background: A new software tool, Optifood, developed by the WHO and based on linear programming (LP) analysis, has been developed to formulate food-based recommendations.

Objective: This study discusses the use of Optifood for predicting whether formulated complementary food (CF) products can ensure dietary adequacy for target populations in Cambodia.

Design: Dietary data were collected by 24-h recall in a cross-sectional survey of 6- to 11-mo-old infants (n = 78). LP model parameters were derived from these data, including a list of foods, median serving sizes, and dietary patterns. Five series of LP analyses were carried out to model the target population’s baseline diet and 4 formulated CF products [WinFood (WF), WinFood-Lite (WF-L), Corn-Soy-Blend Plus (CSB+), and Corn-Soy-Blend Plus Plus (CSB++)], which were added to the diet in portions of 33 g/d dry weight (DW) for infants aged 6–8 mo and 40 g/d DW for infants aged 9–11 mo. In each series of analyses, the nutritionally optimal diet and theoretical range, in diet nutrient contents, were determined.

Results: The LP analysis showed that baseline diets could not achieve the Recommended Nutrient Intake (RNI) for thiamin, riboflavin, niacin, folate, vitamin B-12, calcium, iron, and zinc (range: 14–91% of RNI in the optimal diets) and that none of the formulated CF products could cover the nutrient gaps for thiamin, niacin, iron, and folate (range: 22–86% of the RNI). Iron was the key limiting nutrient, for all modeled diets, achieving a maximum of only 48% of the RNI when CSB++ was included in the diet. Only WF and WF-L filled the nutrient gap for calcium. WF-L, CSB+, and CSB++ filled the nutrient gap for zinc (9- to 11-mo-olds).

Conclusions: The formulated CF products improved the nutrient adequacy of complementary feeding diets but could not entirely cover the nutrient gaps. These results emphasize the value of using LP to evaluate special CF products during the intervention planning phase.

- – -
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trial

In Under-nutrition on February 5, 2014 at 11:18 am

by Lieven Huybregts, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, Patrick Kolsteren.

PLOS Medicine | 1 September 2012 | Volume 9 | Issue 9

(download the paper)

 

Abstract

Background

Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program.

Methods and Findings

We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p<0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (−29.3%; 95% CI: 20.5, 37.2; p<0.001) and fever episodes (−22.5%; 95% CI: 14.0, 30.2; p<0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions.

Conclusions

Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.

 

- – -
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Adult consequences of growth failure in early childhood

In Under-nutrition on January 27, 2014 at 12:17 pm

by John Hoddinott, Jere R Behrman, John A Maluccio, Paul Melgar, Agnes R Quisumbing, Manuel Ramirez-Zea, Aryeh D Stein,
Kathryn M Yount, and Reynaldo Martorell

Am J Clin Nutr 2013;98:1170–8. Printed in USA

(download the paper here)

Abstract

Background: Growth failure is associated with adverse consequences, but studies need to control adequately for confounding.

Objective: We related height-for-age z scores (HAZs) and stunting at age 24 mo to adult human capital, marriage, fertility, health, and economic outcomes.

Design: In 2002–2004, we collected data from 1338 Guatemalan adults (aged 25–42 y) who were studied as children in 1969–1977. We used instrumental variable regression to correct for estimation bias and adjusted for potentially confounding factors.

Results: A 1-SD increase in HAZ was associated with more schooling (0.78 grades) and higher test scores for reading and nonverbal cognitive skills (0.28 and 0.25 SDs, respectively), characteristics of marriage partners (1.39 y older, 1.02 grade more schooling, and 1.01 cm taller) and, for women, a higher age at first birth (0.77 y) and fewer number of pregnancies and children (0.63 and 0.43, respectively). A 1-SD increase in HAZ was associated with increased household per capita expenditure (21%) and a lower probability of living in poverty (10 percentage points). Conversely, being stunted at 2 y was associated with less schooling, a lower test performance, a lower household per capita expenditure, and an increased probability of living in poverty. For women, stunting was associated with a lower age at first birth and higher number of pregnancies and children. There was little relation between either HAZ or stunting and adult health.

Conclusion: Growth failure in early life has profound adverse consequences over the life course on human, social, and economic capital.

- – -
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Follow

Get every new post delivered to your Inbox.

Join 886 other followers

%d bloggers like this: