Home Fortification of Complementary Foods Reduces Anemia and Diarrhea among Children Aged 6-18 Months in Bihar, India: A Large-Scale Effectiveness Trial

Community-Based Child Food Interventions/Supplements for the Prevention of Wasting in Children Up to 5 Years at Risk of Wasting and Nutritional Oedema: A Systematic Review and Meta-Analysis

CONTEXT

Malnutrition poses a significant threat to child health, with millions of children worldwide affected by wasting, which increases the risk of morbidity and mortality.

OBJECTIVE

In this study we sought to evaluate the effectiveness of community-based infant/child food interventions and supplements for preventing wasting among children up to 5 years at risk of wasting and nutritional oedema. The World Health Organization commissioned this review to update their guidelines on wasting due to malnutrition in children.

DATA SOURCES

Nine databases were searched from inception until July 2021 and an updated search was carried out on MEDLINE and Ovid MEDLINE until April 13, 2023, and included 24 studies (98 articles) evaluating the impact of community-based infant/child food interventions/supplements for the prevention of wasting among children up to 5 years.

DATA EXTRACTION

Two review authors independently extracted data and assessed the quality of included studies using the Cochrane Risk of Bias Tool 2.0. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to assess the quality of evidence.

DATA ANALYSIS

This review included 19 cluster-randomized controlled trials (cRCTs) and 5 RCTs evaluating the impact of community-based infant/child food interventions/supplements including fortified blended foods (FBFs), small-quantity (SQ), medium-quantity (MQ), or large-quantity (LQ) lipid-based nutrient supplements (LNS), and multiple micronutrient powder (MNP) for the prevention of wasting among children up to 5 years of age. The analysis showed that infants/children given supplementation with LNS (either SQ, MQ, or LQ) had significantly reduced wasting and significant improvements in weight-for-age z-score, mid-upper-arm circumference (MUAC), and underweight prevalence, along with significant reductions in mortality. The MNP supplementation had little or no impact on wasting but was associated with increased incidences of rapid breathing/chest indrawing and diarrhea morbidity. Overall, the studies were judged to have raised some concerns for the outcomes of wasting and adverse anthropometric indices. However, the GRADE analysis suggested low-to-moderate certainty of outcomes.

CONCLUSIONS

The findings of this review highlight the effectiveness of SQ-LNS and MQ/LQ-LNS supplementation in decreasing rates of wasting, underweight, and mortality and increasing MUAC and weight-for-age z-scores. Methodological limitations in most studies emphasize the need for future trials with direct comparisons of various dietary supplementation strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021277429.

Assessing water, sanitation and hygiene (WASH) practices and their association with diarrhoea in under-five children in urban Chandernagore: Community-based evidence from a small municipal corporation in Hooghly District of West Bengal, India

The study aims to understand the relationship of childhood diarrhoea (under-five children) with water, sanitation and hygiene factors in the light of other contextual factors in an urban setting in the district of Hooghly in West Bengal, India. This primary study was carried out by SIGMA Foundation, Kolkata from 4 to 24 January 2023 across 404 households having at least one under-five child. The findings suggested that the water score was 'good' in 85.1% of the households whereas the hand hygiene score was 'good' in 14.6% of households. More than 90% of the households had piped water supply. Less than half of them treated water before consumption among which 45.3% used cloths for straining water; 59.2% of the caregivers followed safe disposal of child's faeces; 66.8% of households had no handwashing arrangement, and 30.5% had taps and wash basins for handwashing; 20.3% of the under-five children had suffered from diarrhoea in the last month before the survey and its prevalence was higher in children aged 12-23 months. Multivariate results suggested diarrhoea prevalence was lower in households that were pucca and had good water and hand hygiene scores, lower in children that had received iron fortification and whose caregivers followed safe child's stool disposal.

Child-Owned Poultry Intervention Effects on Hemoglobin, Anemia, Concurrent Anemia and Stunting, and Morbidity Status of Young Children in Southern Ethiopia: A Cluster Randomized Controlled Community Trial

Cereal-based diets contribute to anemia in Ethiopian children. Eggs have nutrients to boost hemoglobin levels as well as counter concurrent anemia and stunting (CAS) and morbidity status. A community trial, targeting 6-18 months old children, was conducted in Halaba. Two clusters were randomly selected and allocated to intervention (N = 122) and control (N = 121) arms. Intervention group (IG) children received egg-laying hens with caging in a cultural ceremony declaring child ownership of the chickens. Parents promised to feed eggs to the child. Health and agriculture extension workers promoted egg feeding, poultry husbandry, and sanitation to IG families. Control group (CG) had standard health and agriculture education. At baseline, groups were not different by hemoglobin, anemia, CAS, and morbidity status. Mean hemoglobin was 11.0 mg/dl and anemia prevalence was 41.6%. About 11.9% of children had CAS and 52.3% were sick. Using generalized estimating equations, the intervention increased hemoglobin by 0.53 g/dl (ß:0.53; p < 0.001; 95%CI: 0.28-0.79). IG children were 64% (p < 0.001; odds ratio [OR]:0.36; 95%CI: 0.24-0.54) and 57% (p = 0.007; OR: 0.43; 95%CI: 0.21-0.73) less likely to be anemic and have CAS, respectively, than CG, with no difference in morbidity. Child-owned poultry intervention is recommended in settings where anemia is high and animal-source food intake is low.

The effect of interventions distributing home fortification products on infant and young child feeding (IYCF) practices: A systematic narrative review

Interventions distributing micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements (SQ-LNS), or home fortification products (HFPs), have the potential to improve infant and young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ-LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF-MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ-LNS studies came from randomised trials without an IYCF component (SQ-LNS only) and one from a programme with both IYCF BCC and SfQ-LNS (IYCF-SQ-LNS). Five IYCF-MNP programmes reported positive associations with some IYCF practices-four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ-LNS (one from a related set of randomised controlled trials and the sole IYCF-SQ-LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ-LNS and one found no association with IYCF practices. SQ-LNS and MNP can address nutrient gaps for young children in low-resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.