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Wegmüller R, Musau K, Vergari L, Custer E, Anyango H, Donkor WES, Kiprotich M, Siegal K, Petry N, Wirth JP, Lewycka S, Woodruff BA, Rohner F. Effectiveness of an integrated agriculture, nutrition-specific, and nutrition-sensitive program on child growth in Western Kenya: a cluster-randomized controlled trial. Am J Clin Nutr 2022; 116:446-459. [PMID: 35421217 PMCID: PMC9348977 DOI: 10.1093/ajcn/nqac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stunting rates remain unacceptably high in many regions, including sub-Saharan Africa. Agricultural programs have led to increased yields and household incomes but showed limited success in improving nutritional status. OBJECTIVES We assessed whether linear growth could be improved through a potentially scalable, integrated program adding nutrition-specific and nutrition-sensitive components to an existing agricultural program. METHODS In this cluster-randomized controlled trial in rural Western Kenya, we randomized children aged 6-35 months from farming families to an agricultural intervention without (control group) or with a bundle of interventions (intervention group), including distribution of micronutrient powders (MNP), poultry to increase egg consumption, seeds of greens and onions, and soap and chlorine solution, as well as provision of monthly behavior change trainings. The primary outcome was the change in height-for-age z-score (HAZ) over 2 years of follow-up. We assessed safety through active morbidity and passive adverse event monitoring. We conducted an intention-to-treat analysis, followed by per-protocol and prespecified subgroup analyses. RESULTS From March to April 2018, we enrolled 1927 children from 126 clusters (control, 942 children in 63 clusters; intervention, 985 children in 63 clusters). Data on HAZ were available for 1672 (86.6%) children after 2 years. Adherence was >80% for use of MNP, chlorine, and greens and receipt of soap, and ∼40% for egg and red onion consumption. The intention-to-treat analysis indicated a greater change in HAZ over 2 years in the intervention group (adjusted effect size, 0.11; 95% CI: 0.02-0.19). We found a slightly stronger effect in the per-protocol analysis (adjusted effect size, 0.15; 95% CI: 0.06-0.24). Dietary diversity and consumption of iron-rich foods were improved in the intervention group, and reported instances of fever, lower respiratory tract infections, and diarrheal episodes were lower in the intervention group. CONCLUSIONS This study found a modest improvement in linear growth, indicating the need for multiple, integrated interventions to achieve benefits. The trial was registered with clinicaltrials.gov as NCT03448484.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sonia Lewycka
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK,Oxford University Clinical Research Unit, Hanoi, Vietnam
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Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review. Wellcome Open Res 2020; 5:62. [PMID: 33102783 PMCID: PMC7569484 DOI: 10.12688/wellcomeopenres.15781.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs and cost-effectiveness of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods: We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. We also assessed the cost effectiveness of community-based management of malnutrition programs (CMAM). Cost per disability adjusted life year (DALY) averted for a CMAM program integrated into existing health services in Malawi was $42. Overall, cost per DALY averted for CMAM ranged between US$26 and US$53, which was much lower than facility-based management (US$1344). Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.
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Affiliation(s)
- Rebecca G Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Julie Jemutai
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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Pereira de Jesus Costa AC, Kelly dos Santos Silva M, Batista de Oliveira S, Silva LL, Silva AC, Barroso RB, Macedo Costa JDR, Lima Hunaldo VK, Neto MS, Pascoal LM, Nascimento Sá Ewerton Martins MC, Santos FS, Hunaldo dos Santos L, Pereira Santos GW, Alves de Oliveira Serra MA, Siqueira de Araújo Gordon A, Moura de Araújo T, de Araújo MFM. Effects of Cashew Nut ( Anacardium occidentale L.) Seed Flour in Moderately Malnourished Children: Randomized Clinical Trial. J Nutr Metab 2020; 2020:6980754. [PMID: 32455002 PMCID: PMC7222489 DOI: 10.1155/2020/6980754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/22/2020] [Accepted: 03/24/2020] [Indexed: 01/13/2023] Open
Abstract
The monitoring and combined use of dietary supplements to restore adequate growth are paramount and highly recommended in child malnutrition, an important public health problem. The objective of this study was to analyze the effects of cashew nut seed flour in children with moderate malnutrition, treated at primary healthcare services. This is a randomized clinical trial conducted from April to October 2017 in the city of Imperatriz, Brazil. The sample comprised 30 children born at term, aged between 2 and 5 years, and newly diagnosed with malnutrition (60 days or less), randomized into experimental and control groups. The intervention consisted of daily intake of cashew nut seed flour. There was intragroup statistically significant difference in the glucose levels of children who were assigned to the control group (p=0.02) and in the glycated hemoglobin in the experimental group (p < 0.01). Intergroup analysis of glycated hemoglobin levels showed statistically significant differences in favor of the experimental group (p=0.01). HDL and LDL had, respectively, increased and decreased in the experimental group. The use of cashew nut seed flour in a 24-week period had positive effects on glycated hemoglobin, HDL, and LDL parameters in moderately malnourished children.
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Affiliation(s)
| | | | | | - Luana Leite Silva
- Nursing Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | - Alessandra Cruz Silva
- Nursing Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | - Raidanes Barros Barroso
- Nursing Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | | | - Virlane Kelly Lima Hunaldo
- Food Engineering Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | - Marcelino Santos Neto
- Nursing Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | - Lívia Maia Pascoal
- Nursing Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | | | - Floriacy Stabnow Santos
- Nursing Department, Maranhão Federal University, University Avenue, S/N, Imperatriz, MA, Brazil
| | | | | | | | | | - Thiago Moura de Araújo
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, José Franco de Oliveira Street, S/N, Redenção, CE, Brazil
| | - Márcio Flávio Moura de Araújo
- Health Sciences Institute, University for International Integration of the Afro-Brazilian Lusophony, José Franco de Oliveira Street, S/N, Redenção, CE, Brazil
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Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review. Wellcome Open Res 2020; 5:62. [DOI: 10.12688/wellcomeopenres.15781.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods: We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.
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Marquer C, Langendorf C, Woi-Messe LC, Berthe F, Ategbo EA, Rodas-Moya S, dePee S, Grais RF. Intrahousehold management and use of nutritional supplements during the hunger gap in Maradi region, Niger: a qualitative study. BMC Nutr 2020; 6:4. [PMID: 32190344 PMCID: PMC7066835 DOI: 10.1186/s40795-019-0329-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/10/2019] [Indexed: 12/03/2022] Open
Abstract
Background Nutritional supplements are used for preventing and treating childhood malnutrition. While there is a growing body of evidence on product efficacy, less emphasis has been placed on how they are perceived and used at the household level. Here, we report on the intrahousehold management of three different supplements (Ready to Use Supplementary food (RUSF), medium quantity lipid-based nutrient supplements (LNS-MQ) and Super Cereal Plus (SC+)) in the region of Maradi (Niger). The main objective of this study was to describe the use, consumption and perception of the three different nutritional products at the household level. Methods The study was conducted in the Madarounfa district in the region of Maradi (February – March 2012). Female caregivers were purposely selected from eligible households and invited to participate. Data were collected through focus group discussion and interviews and were analyzed using thematic content analysis. Results In total, 114 caregivers participated. Three major themes were initially identified and included preparation and conservation; consumption and sharing practices as well as perception of impact. The data showed good acceptance at the household level including perceived benefits for the target children, health improvement, prevention of illness and malnutrition. Sharing and gifting at both household and community level were also reported. Conclusions Caregivers displayed positive perceptions toward the investigated supplements. Patterns of actual management should be considered in the design, implementation, monitoring and evaluation of future programs.
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Affiliation(s)
| | | | | | | | | | - Santiago Rodas-Moya
- 4Nutrition Division (OSN), World Food Programme, Rome, Italy.,5Nutrition and Health Division, Wageningen University, Wageningen, Netherlands
| | - Saskia dePee
- 4Nutrition Division (OSN), World Food Programme, Rome, Italy.,5Nutrition and Health Division, Wageningen University, Wageningen, Netherlands.,6Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
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6
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Cliffer IR, Nikiema L, Langlois BK, Zeba AN, Shen Y, Lanou HB, Suri DJ, Garanet F, Chui K, Vosti S, Walton S, Rosenberg I, Webb P, Rogers BL. Cost-Effectiveness of 4 Specialized Nutritious Foods in the Prevention of Stunting and Wasting in Children Aged 6-23 Months in Burkina Faso: A Geographically Randomized Trial. Curr Dev Nutr 2020; 4:nzaa006. [PMID: 32072130 PMCID: PMC7013080 DOI: 10.1093/cdn/nzaa006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/06/2019] [Accepted: 01/16/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is a variety of specialized nutritious foods available for use in programs targeting undernutrition, but evidence supporting the choice of product is limited. OBJECTIVES We compared the cost-effectiveness of 4 specialized nutritious foods to prevent stunting and wasting in children aged 6-23 mo in Burkina Faso. METHODS Four geographic regions were randomly assigned to 1 of 4 intervention arms: Corn-Soy Blend Plus (CSB+) programmed with separate fortified vegetable oil (the reference food), Corn-Soy-Whey Blend (CSWB; a new formulation) with oil, SuperCereal Plus (SC+), and ready-to-use supplementary food (RUSF). We compared the effects of each intervention arm on growth (length-for-age z score (LAZ), weight-for-length z score (WLZ), end-line stunting (LAZ < -2), and total monthly measurements of wasting (WLZ < -2). Rations were ∼500 kcal/d, distributed monthly. Children were enrolled in the blanket supplementary feeding program at age ∼6 mo and measured monthly for ∼18 mo. Average costs per child reached were linked with effectiveness to compare the cost-effectiveness of each arm with CSB+ with oil. RESULTS In our sample of 6112 children (CSB+, n = 1519; CSWB, n = 1503; SC+, n = 1564; RUSF, n = 1526), none of the foods prevented declines in growth. Children in the SC+ and RUSF arms were not significantly different than those in the CSB+ with oil arm. Children in the CSWB with oil arm experienced higher end-line (measurement at age 22.9-23.9 mo) stunting (OR: 2.07; 95% CI: 1.46, 2.94) and more months of wasting (incidence rate ratio: 1.29; 95% CI: 1.09, 1.51). CSB+ with oil was the least-expensive ration in all costing scenarios ($113-131 2018 US dollars/enrolled child) and similar in effectiveness to SC+ and RUSF, and thus the most cost-effective product for the defined purposes. CONCLUSIONS CSB+ with oil was the most cost-effective ration in the prevention of wasting and stunting in this trial. This trial was registered at clinicaltrials.gov as NCT02071563.
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Affiliation(s)
- Ilana R Cliffer
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Laetitia Nikiema
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Breanne K Langlois
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Augustin N Zeba
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Ye Shen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Hermann B Lanou
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Devika J Suri
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Nutritional Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Franck Garanet
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Kenneth Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, Social Sciences and Humanities, University of California, Davis, Davis, CA, USA
| | - Shelley Walton
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Irwin Rosenberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Das JK, Salam RA, Hadi YB, Sadiq Sheikh S, Bhutta AZ, Weise Prinzo Z, Bhutta ZA. Preventive lipid-based nutrient supplements given with complementary foods to infants and young children 6 to 23 months of age for health, nutrition, and developmental outcomes. Cochrane Database Syst Rev 2019; 5:CD012611. [PMID: 31046132 PMCID: PMC6497129 DOI: 10.1002/14651858.cd012611.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND One nutritional intervention advocated to prevent malnutrition among children is lipid-based nutrient supplements (LNS). LNS provide a range of vitamins and minerals, but unlike most other micronutrient supplements, LNS also provide energy, protein and essential fatty acids. Alternative recipes and formulations to LNS include fortified blended foods (FBF), which are foods fortified with vitamins and minerals, and micronutrient powders (MNP), which are a combination of vitamins and minerals, OBJECTIVES: To assess the effects and safety of preventive LNS given with complementary foods on health, nutrition and developmental outcomes of non-hospitalised infants and children six to 23 months of age, and whether or not they are more effective than other foods (including FBF or MNP).This review did not assess the effects of LNS as supplementary foods or therapeutic foods in the management of moderate and severe acute malnutrition. SEARCH METHODS In October 2018, we searched CENTRAL, MEDLINE, Embase, 21 other databases and two trials registers for relevant studies. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies and other experts in the area for any ongoing and unpublished studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that evaluated the impact of LNS plus complementary foods given at point-of-use (for any dose, frequency, duration) to non-hospitalised infants and young children aged six to 23 months in stable or emergency settings and compared to no intervention, other supplementary foods (i.e. FBF), nutrition counselling or multiple micronutrient supplements or powders for point-of-use fortification of complementary foods. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for relevance and, for those studies included in the review, extracted data, assessed risk of bias and rated the quality of the evidence using the GRADE approach. We carried out statistical analysis using Review Manager software. We used a random-effects meta-analysis for combining data as the interventions differed significantly. We set out the main findings of the review in 'Summary of findings' tables,. MAIN RESULTS Our search identified a total of 8124 records, from which we included 17 studies (54 papers) with 23,200 children in the review. The included studies reported on one or more of the pre-specified primary outcomes, and five studies included multiple comparison groups.Overall, the majority of trials were at low risk of bias for random sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective reporting and other sources of bias, but at high risk of bias for blinding of participants and personnel due to the nature of the intervention. Using the GRADE approach, we judged the quality of the evidence for most outcomes as low or moderate.LNS+complementary feeding compared with no intervention Thirteen studies compared LNS plus complementary feeding with no intervention. LNS plus complementary feeding reduced the prevalence of moderate stunting by 7% (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.88 to 0.98; nine studies, 13,372 participants; moderate-quality evidence), severe stunting by 15% (RR 0.85, 95% CI 0.74 to 0.98; five studies, 6151 participants; moderate-quality evidence), moderate wasting by 18% (RR 0.82, 95% CI 0.74 to 0.91; eight studies; 13,172 participants; moderate-quality evidence), moderate underweight by 15% (RR 0.85, 95% CI 0.80 to 0.91; eight studies, 13,073 participants; moderate-quality evidence), and anaemia by 21% (RR 0.79, 95% CI 0.69 to 0.90; five studies, 2332 participants; low-quality evidence). There was no impact of LNS plus complementary feeding on severe wasting (RR 1.27, 95% CI 0.66 to 2.46; three studies, 2329 participants) and severe underweight (RR 0.78, 95%CI 0.54 to 1.13; two studies, 1729 participants). Adverse effects did not differ between the groups (RR 0.86, 95% CI 0.74 to 1.01; three studies, 3382 participants).LNS+complementary feeding compared with FBF Five studies compared LNS plus complementary feeding with other FBF, including corn soy blend and UNIMIX. We pooled four of the five studies in meta-analyses and found that, when compared to other FBF, LNS plus complementary feeding significantly reduced the prevalence of moderate stunting (RR 0.89, 95% CI 0.82 to 0.97; three studies, 2828 participants; moderate-quality evidence), moderate wasting (RR 0.79, 95% CI 0.65 to 0.97; two studies, 2290 participants; moderate-quality evidence), and moderate underweight (RR 0.81, 95% CI 0.73 to 0.91; two studies, 2280 participants; moderate-quality evidence). We found no difference between LNS plus complementary feeding and FBF for severe stunting (RR 0.41, 95% CI 0.12 to 1.42; two studies, 729 participants; low-quality evidence), severe wasting (RR 0.64, 95% CI 0.19 to 2.81; two studies, 735 participants; moderate-quality evidence), and severe underweight (RR 1.23, 95% CI 0.67 to 2.25; one study, 173 participants; low-quality evidence).LNS+complementary feeding compared with MNP Four studies compared LNS plus complementary feeding with MNP. We pooled data from three of the four studies in meta-analyses and found that compared to MNP, LNS plus complementary feeding significantly reduced the prevalence of moderate underweight (RR 0.88, 95% CI 0.78 to 0.99; two studies, 2004 participants; moderate-quality evidence) and anaemia (RR 0.38, 95% CI 0.21 to 0.68; two studies, 557 participants; low-quality evidence). There was no difference between LNS plus complementary feeding and MNP for moderate stunting (RR 0.92, 95% CI 0.82 to 1.02; three studies, 2365 participants) and moderate wasting (RR 0.97, 95% CI 0.77 to 1.23; two studies, 2004 participants). AUTHORS' CONCLUSIONS The findings of this review suggest that LNS plus complementary feeding compared to no intervention is effective at improving growth outcomes and anaemia without adverse effects among children aged six to 23 months in low- and middle-income countries (LMIC) in Asia and Africa, and more effective if provided over a longer duration of time (over 12 months). Limited evidence also suggests that LNS plus complementary feeding is more effective than FBF and MNP at improving growth outcomes.
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Affiliation(s)
- Jai K Das
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Yousaf Bashir Hadi
- West Virginia UniversityDepartment of Internal Medicine1 Medical Center DriveMorgantownWest VirginiaUSA26506
| | - Sana Sadiq Sheikh
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Afsah Z Bhutta
- Dow University of Health SciencesKarachiSindhPakistan75500
| | - Zita Weise Prinzo
- World Health OrganizationDepartment of Nutrition for Health and DevelopmentAvenue Appia 20GenevaGESwitzerland1211
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoCanada
- Aga Khan University HospitalCenter for Excellence in Women and Child HealthKarachiPakistan
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Abstract
This article looks at both nutrition and early childhood stimulation interventions as part of an integrated life cycle approach to development. We build on recent systematic reviews of child development, which are comprehensive in regard to what is currently known about outcomes reported in key studies. We then focus particularly on implementation, scaling, and economic returns, drawing mainly on experience in low- and middle-income countries where undernutrition and poor child development remain significant public health challenges with implications across the life course.
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Affiliation(s)
- Harold Alderman
- International Food Policy Research Institute, Washington, DC 20006;
| | - Lia Fernald
- Community Health Sciences, School of Public Health, University of California, Berkeley, California 94720;
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Ford ND, Martorell R, Mehta NK, Ramirez-Zea M, Stein AD. Life-Course Body Mass Index Trajectories Are Predicted by Childhood Socioeconomic Status but Not Exposure to Improved Nutrition during the First 1000 Days after Conception in Guatemalan Adults. J Nutr 2016; 146:2368-2374. [PMID: 27655759 PMCID: PMC5086792 DOI: 10.3945/jn.116.236075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Latin America has experienced increases in obesity. Little is known about the role of early life factors on body mass index (BMI) gain over the life course. OBJECTIVE The objective of this research was to examine the role of early life factors [specifically, nutrition supplementation during the first 1000 d (from conception to 2 y of age) and childhood household socioeconomic status (SES)] on the pattern of BMI gain from birth or early childhood through midadulthood by using latent class growth analysis. METHODS Study participants (711 women, 742 men) who were born in 4 villages in Guatemala (1962-1977) were followed prospectively since participating in a randomized nutrition supplementation trial as children. Sex-specific BMI latent class trajectories were derived from 22 possible measures of height and weight from 1969 to 2004. To characterize early life determinants of BMI latent class membership, we used logistic regression modeling and estimated the difference-in-difference (DD) effect of nutrition supplementation during the first 1000 d. RESULTS We identified 2 BMI latent classes in women [low (57%) and high (43%)] and 3 classes in men [low (38%), medium (47%), and high (15%)]. Nutrition supplementation during the first 1000 d after conception was not associated with BMI latent class membership (DD test: P > 0.15 for men and women), whereas higher SES was associated with increased odds of high BMI latent class membership in both men (OR: 1.98; 95% CI: 1.09, 3.61) and women (OR: 1.62; 95% CI: 1.07, 2.45) for the highest relative to the lowest tertile. CONCLUSIONS In a cohort of Guatemalan men and women, nutrition supplementation provided during the first 1000 d was not significantly associated with higher BMI trajectory. Higher childhood household SES was associated with increased odds of high BMI latent class membership relative to the poorest households. The pathways through which this operates still need to be explored.
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Affiliation(s)
- Nicole D Ford
- Nutrition and Health Sciences Program, Laney Graduate School, and
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, and,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and
| | - Neil K Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and
| | - Manuel Ramirez-Zea
- Institute of Nutrition of Central America and Panama Research Center for the Prevention of Chronic Diseases (CIIPEC), Guatemala City, Guatemala
| | - Aryeh D Stein
- Nutrition and Health Sciences Program, Laney Graduate School, and .,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; and
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