scholarly journals Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh

2019 ◽  
Vol 109 (1) ◽  
pp. 148-164 ◽  
Author(s):  
Christine P Stewart ◽  
Kathryn G Dewey ◽  
Audrie Lin ◽  
Amy J Pickering ◽  
Kendra A Byrd ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Control Group ◽  
Lower Prevalence ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Nutrient Supplements ◽  
Micronutrient Status ◽  
Infant And Young Child ◽  
Cluster Randomized ◽  
Prevalence Of Anemia

ABSTRACTBackgroundAnemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene.ObjectiveWe evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh.DesignWe nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6–24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs.ResultsIn Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102).ConclusionsIYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention.These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).

scholarly journals An Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention Does Not Affect Anemia, Iron Status, or Vitamin A Status among Children Aged 12–23 Months in Eastern Uganda

2020 ◽  
Vol 150 (4) ◽  
pp. 938-944 ◽  
Author(s):  
Nicole D Ford ◽  
Laird J Ruth ◽  
Sarah Ngalombi ◽  
Abdelrahman Lubowa ◽  
Siti Halati ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Young Child ◽  
Vitamin A ◽  
Deficiency Anemia ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Micronutrient Status ◽  
Infant And Young Child ◽  
Eastern Uganda ◽  
Soda Ash

ABSTRACT Background Micronutrient powders (MNP) can reduce iron deficiency and anemia in children. Objective We evaluated the impact of an integrated infant and young child feeding (IYCF)–MNP intervention on anemia and micronutrient status among children aged 12–23 mo in Eastern Uganda. The intervention focused on MNP distribution, IYCF education, and caregiver behavior change. Methods Population-based cross-sectional surveys representative of children aged 12–23 mo in Amuria (intervention) and Soroti (nonintervention) districts were collected in June/July 2015 at baseline (n = 1260) and 12 mo after implementation at endline in 2016 (n = 1490). From pooled capillary blood, we assessed hemoglobin, malaria, ferritin, retinol binding protein (RBP), C-reactive protein, and ɑ1-acid glycoprotein. Ferritin and RBP were regression-adjusted to correct for inflammation. Caregivers reported sociodemographic characteristics and MNP knowledge and practices. Linear regression estimated the difference-in-difference (DiD) effect of MNP on hemoglobin, ferritin, and RBP, and logistic regression estimated DiD effect of MNP on anemia (hemoglobin <11.0 g/dL), iron deficiency (ferritin <12.0 µg/L), iron deficiency anemia (hemoglobin <11.0 g/dL and ferritin <12.0 µg/L), and vitamin A deficiency (VAD; RBP equivalent to <0.70 µmol/L retinol: <0.79 µmol/L at baseline and RBP <0.67 µmol/L at endline). Results In Amuria, 96% of children had ever consumed MNP versus <1% of children in Soroti. Fifty-four percent of caregivers reported organoleptic changes when MNP were added to foods cooked with soda ash. Adjusting for age, sex, malaria, recent morbidity, and household-level factors, the intervention was associated with −0.83 g/dL lower hemoglobin (95% CI, −1.36, −0.30 g/dL; P = 0.003) but not with anemia, ferritin, iron deficiency, iron deficiency anemia, RBP, or VAD. Conclusions Despite high program fidelity, the intervention was associated with reduced hemoglobin concentrations but not with change in anemia or micronutrient status among children aged 12–23 mo in Eastern Uganda. Contextual factors, such as cooking with soda ash, might explain the lack of effectiveness.

scholarly journals Lipid-Based Nutrient Supplementation Reduces Child Anemia and Increases Micronutrient Status in Madagascar: A Multiarm Cluster-Randomized Controlled Trial

2020 ◽  
Vol 150 (4) ◽  
pp. 958-966 ◽  
Author(s):  
Christine P Stewart ◽  
Lia C H Fernald ◽  
Ann M Weber ◽  
Charles Arnold ◽  
Emanuela Galasso
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Iron Status ◽  
Deficiency Anemia ◽  
Growth Monitoring ◽  
Lower Prevalence ◽  
Blood Draw ◽  
Micronutrient Status ◽  
Cluster Randomized ◽  
Prevalence Of Anemia

ABSTRACT Background Iron deficiency anemia affects hundreds of millions of women and children worldwide and is associated with impaired infant outcomes. Small-quantity lipid-based nutrient supplement (LNS) have been found to reduce the prevalence of anemia and iron deficiency in some trials. Objectives We evaluated the effectiveness of daily LNS supplementation on child anemia and micronutrient status in Madagascar within the context of an existing, scaled-up nutrition program. Methods We cluster-randomized 125 communities to (T0) a routine program with monthly growth monitoring and nutrition education; (T1) T0 + home visits for intensive nutrition counselling; (T2) T1 + LNS for children aged 6–18 mo; (T3) T2 + LNS for pregnant/lactating women; or (T4) T1 + parenting messages. Pregnant women and infants aged <12 mo were enrolled in 2014 and followed for 2 y. Child outcome measures included hemoglobin and anemia assessed using the HemoCue 301 system (n = 3561), and serum ferritin and soluble transferrin receptor as markers of iron status, retinol-binding protein as a marker of vitamin A status, and C-reactive protein and α-1 acid glycoprotein from a finger stick blood draw among a subsample (n = 387). We estimated mean difference using linear regression and prevalence ratios using modified Poisson regression accounting for the clustered design. All analyses were intention-to-treat. Results Children in the LNS groups (T2 and T3) had ∼40% lower prevalence of anemia and iron deficiency anemia and 25% lower prevalence of iron deficiency than children in the control group (T0) (P < 0.05 for all). There were no differences in any of the biomarkers when comparing children in the T4 group with those in T0; nor were there differences between T3 and T2. Conclusions Our findings suggest the provision of LNS in the context of a large-scale program offers significant benefits on anemia and iron status in young children. This trial was registered at www.isrctn.com as ISRCTN14393738.

Impact of Small-quantity Lipid-based Nutrient Supplements on Infant and Young Child Feeding Practices

2015 ◽  
Vol 5 (5) ◽  
pp. 904-905
Author(s):  
Mary Arimond ◽  
Souheila Abbeddou ◽  
Seth Adu-Afarwuah ◽  
Ulla Ashorn ◽  
Kenneth Brown ◽  
...  
Keyword(s):  
Young Child ◽  
Feeding Practices ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Nutrient Supplements ◽  
Child Feeding Practices ◽  
Infant And Young Child

scholarly journals Improving caregivers’ infant and young child-feeding practices using a three-group food guide: A randomized intervention study in central Uganda

2021 ◽  
Vol 21 (04) ◽  
pp. 17834-17853
Author(s):  
Edward Kansiime ◽  
◽  
MK Kabahenda ◽  
E Bonsi ◽  
◽  
...  
Keyword(s):  
Young Child ◽  
Nutrition Education ◽  
Dietary Diversity ◽  
Feeding Practices ◽  
Growth Patterns ◽  
Control Group ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Child Feeding Practices ◽  
Infant And Young Child

Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30yearsremained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%,respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples,there is need to improve the population’s awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards)that were developed by United Nations Children’s Fund (UNICEF), are currently the standard package used in Uganda’s health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards.A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a three-foodgroup guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status.At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores,which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p =0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-for-age (p = 0.03) Z-scores.These findings,therefore,indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards.Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth.

scholarly journals Small-quantity lipid-based nutrient supplements for prevention of child malnutrition and promotion of healthy development: Overview of individual participant data meta-analysis and programmatic implications

2021 ◽  
Author(s):  
Kathryn G. Dewey ◽  
Christine P. Stewart ◽  
K. Ryan Wessells ◽  
Elizabeth L. Prado ◽  
Charles D. Arnold
Keyword(s):  
Child Development ◽  
Iron Deficiency ◽  
Meta Analysis ◽  
Deficiency Anemia ◽  
Control Group ◽  
Individual Participant Data ◽  
Lower Prevalence ◽  
Beneficial Effects ◽  
Nutrient Supplements ◽  
Individual Participant

AbstractSmall-quantity lipid-based nutrient supplements (SQ-LNS) were designed to provide multiple micronutrients within a food base that also provides energy, protein and essential fatty acids, and were targeted towards the prevention of malnutrition in low- and middle-income countries. Previous meta-analyses have demonstrated beneficial effects of SQ-LNS on child growth, anemia and mortality. To further examine efficacy and effectiveness of SQ-LNS, and explore study-level and individual-level modifiers of the effects, we conducted an individual participant data (IPD) meta-analysis of 14 randomized controlled trials of SQ-LNS provided to infants and young children 6 to 24 mo of age (n > 37,000). We examined growth, development, anemia and micronutrient status outcomes. Children who received SQ-LNS had a 12-14% lower prevalence of stunting, wasting and underweight, were 16-19% less likely to score in the lowest decile for language, social-emotional, and motor development, and had a 16% lower prevalence of anemia and 64% lower prevalence of iron-deficiency anemia, compared to control group children. For most outcomes, beneficial effects of SQ-LNS were evident regardless of study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact or average reported compliance with SQ-LNS. For certain outcomes, targeting based on population-level socioeconomic status or undernutrition may be worthwhile, as the benefits of SQ-LNS for iron status, anemia and child development were larger in sub-groups with a greater potential to benefit. A greater impact of SQ-LNS might be possible by co-packaging it with interventions that reduce constraints on response, such as prevention and control of pre-and postnatal infections, improving maternal nutrition, improving health care access, and promotion of early child development. Policy-makers and program planners should consider including SQ-LNS in strategies to reduce child mortality, stunting, wasting, anemia, iron deficiency and developmental impairments. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592, CRD42020159971 and CRD42020156663.

scholarly journals A study of correlation of different grades of malnutrition with feeding practices during 1st 6 months of life

2017 ◽  
Vol 4 (2) ◽  
pp. 460
Author(s):  
Diksha Sharma ◽  
Devendra Sareen ◽  
Subhash Bamnawat
Keyword(s):  
Exclusive Breastfeeding ◽  
Rural Areas ◽  
Control Group ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Under Nutrition ◽  
Infant And Young Child ◽  
Significant Difference ◽  
And Control ◽  
Critical Public Health

Background: Childhood under nutrition is a critical public health and development challenge in many developing countries including India. Nearly half of all deaths in children under-5 age group are attributable to under-nutrition. One of the key reasons for under-nutrition in early life is the faulty and sub-optimal infant and young child feeding practices.Methods: 295 children under the age of 5 years residing in rural areas of Udaipur were studied. Feeding pattern and various demographic factors were taken into account, considering age at which breastfeeding was initiated, practice of exclusive breastfeeding up to 6 months, colostrum given or not, any pre-lacteal feed given or not. Assessment of anthropometric measurements was done and children were categorized as per classification of malnutrition by the WHO.Results: Total of 295 children were studied, out of which 59% (174) children were malnourished. 23.2% of SAM children received exclusive breastfeeding up to 6 months compared to 52.1% of control group, which was statistically significant. Difference between severely malnourished and control group children who received pre-lacteal feed was also significant. Only 21% of severely malnourished children were started with breastfeeding within 1st hour of birth.Conclusions: Most of the children who were not given breastfeeding up to 6 months, offered pre-lacteal feed, deprived of colostrum at birth, not started complementary feeding at appropriate time were severely malnourished. 

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