scholarly journals Knowledge, Food Vouchers, and Child Nutrition: Evidence from a Field Experiment in Ethiopia (P11-116-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Seollee Park ◽  
Yae Eun Han ◽  
Hyuncheol Kim
Keyword(s):  
Child Nutrition ◽  
Dietary Diversity ◽  
Study Groups ◽  
Child Growth ◽  
Control Group ◽  
Maternal Knowledge ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Change Communication ◽  
Randomized Design

Abstract Objectives Young children in developing countries often maintain poor diets, evidenced by strikingly low dietary diversity. Through formative research, we identified the lack of knowledge and affordability as key barriers to improved infant and young child feeding (IYCF) practices in Ethiopia. The aim of this study is to investigate ways to promote healthy IYCF by analyzing the impacts of an IYCF behavior change communication (BCC) program and food vouchers on mother's IYCF knowledge and practices, and child growth. Methods Using a clustered randomized design, we compare the effects of two independent interventions—IYCF BCC program and food vouchers—on four study groups: BCC only (BCC), voucher only (Voucher), BCC and voucher (BCC + Voucher), and the control group. The BCC program offered weekly group IYCF sessions to mothers who has children between 4 to 20 months of age for 16 weeks, employing participatory learning methods. The voucher program provided food vouchers worth approximately 10 USD per month for four months, which could be used at nearby markets for purchasing a wide variety of food items. We identified 641 eligible households residing in 79 villages in Ejere through census. As shown in Figure 1, 79 villages were randomly assigned to one of the four study groups: BCC, Voucher, BCC + Voucher, and control. All eligible mothers living in treatment villages were invited to participate in the program to which the village she lives in was assigned. Results We show that BCC improves maternal knowledge of nutrition and IYCF behaviors, while food vouchers alone do not (Figure 2). Impacts are largest when both knowledge and income constraints are addressed simultaneously through BCC + Voucher (Table 1). Only in this group do we see these treatments reducing stunting by 9 percentage points (Figure 3). Moreover, we show that BCC + Voucher prevented stunting from occurring during this critical age range rather than reversing it (Figure 4). Conclusions Our results suggest that, when both knowledge and income are intertwined challenges for improved child-feeding practices, addressing both constraints simultaneously may augment the positive impacts due to their complementary relationship. Funding Sources Africa Future Foundation. Supporting Tables, Images and/or Graphs

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 An Innovative Grandmother-Inclusive Approach for Addressing Suboptimal Infant and Young Child Feeding Practices in Sierra Leone

2020 ◽  
Vol 4 (12) ◽  
Author(s):  
Bridget A Aidam ◽  
Carolyn A MacDonald ◽  
Rebecca Wee ◽  
Joseph Simba ◽  
Judi Aubel ◽  
...  
Keyword(s):  
Young Child ◽  
Nutrition Education ◽  
Sierra Leone ◽  
Child Nutrition ◽  
Dietary Diversity ◽  
Intervention Group ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Infant And Young Child ◽  
Inclusive Approach

ABSTRACT Background Suboptimal infant and young child feeding (IYCF) practices contribute to child undernutrition. Sierra Leone Demographic and Health Survey data show that IYCF practices remain poor despite modest improvements. Recent studies have identified the role of grandmothers as critical to child nutrition; however, in Sierra Leone to date, the potential for grandmothers to influence IYCF practices has not been investigated. Objectives We examined how an innovative grandmother-inclusive approach (GMIA) can be used to address suboptimal IYCF practices. Methods Using a quasi-experimental design, we compared IYCF beliefs and practices between GMIA intervention communities (receiving monthly dialogue sessions on nutrition, quarterly community praise sessions, and intergenerational forums) and comparison communities (receiving standard nutrition education) in Bum chiefdom from 2013 and 2016. The quantitative endline survey targeted 101 pregnant women, 291 women with children aged <2 y, and 219 grandmothers. Statistical analyses utilized t tests and χ2 tests to examine differences between intervention and comparison communities at endline. Multivariate regression was used to determine the intervention's effect on IYCF outcomes of interest. Results Awareness of and participation in the GMIA was high among mothers and grandmothers in intervention communities. The percentage of infants and young children aged 0–23 mo (n = 291) exclusively breastfed during the first week of life was significantly higher in the intervention group (90.2% compared with 79.4%, P = 0.01). Among infants aged 6–23 mo (n = 219), the percentage achieving minimum dietary diversity and minimum acceptable diet was significantly higher in the intervention group (77.2% compared with 51.8%, P < 0.001; and 53.8% compared with 22.6%, P < 0.001, respectively). Differences in percentages achieving minimum meal frequency (MMF) were only significant for infants aged 9–23 mo, with the intervention group achieving a higher MMF (54.6% compared with 36.9%, P = 0.02). Conclusions Results suggest that a GMIA that recognizes grandmothers’ roles and strengthens their knowledge can contribute to improved IYCF practices.

Influence of Infant and Young Child Feeding Practices on Stunting in Children Aged 6 – 23 Months in Zambia 

2021 ◽  
Author(s):  
Andrew Banda ◽  
Elizabeth T. Nyirenda ◽  
Chabila C. Mapoma ◽  
Bwalya B. Bwalya ◽  
Nkuye Moyo
Keyword(s):  
Child Nutrition ◽  
Dietary Diversity ◽  
Public Health Problem ◽  
Feeding Practices ◽  
Meal Frequency ◽  
Chi Square ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Main Determinants ◽  
Minimum Dietary Diversity

Abstract Background Infant and child nutrition in Zambia remains a pressing public health problem. The Zambia Demographic and Health Survey (ZDHS) indicates that 35% of children under-five and 36 % among those aged 6-23 months are stunted. This study set out to assess the influence of Infant and Child Feeding (IYCF) practices on child stunting (6-23 months) in Zambia. Methods The 2008 ZDHS children’s data were analysed to measure stunting among infants aged 6-23 months. We fitted a bivariate logistic regression to measure association between feeding practices and stunting in children. Pearson’s Chi-square test of proportions measuring differences in proportions and adjusted odd ratios (AOR) with confidence intervals at 95% are reported. Results Findings indicate that 36% were stunted. IYCF practices indicators remain relatively poor in Zambia with only 13% of children age 6-23 months having received minimum acceptable diet, 23% received minimum dietary diversity and 42% received minimum meal frequency. Breastfeeding and receipt of a minimum dietary diversity reduced the odds of stunting among children age 6-23 months by 38% and 33% respectively. A child's perceived low birth size, being male, maternal anaemia status and mother's use of the internet were significant predictors of stunting.Conclusion We conclude that IYCF practices have an influence on stunting in Zambia and that socio-economic and demographic factors are likewise associated with stunting although the main determinants are amendable to intervention. Promoting the recommended WHO IYCF practices; breastfeeding, minimum meal frequency, receiving foods with diverse dietary content and accelerated investment in nutrition programs is recommended.

scholarly journals Maternal Knowledge, Attitudes, and Practices of Complementary Feeding and Child Undernutrition in the Vakinankaratra Region of Madagascar: A Mixed-Methods Study

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Hasina Rakotomanana ◽  
Deana Hildebrand ◽  
Gail E Gates ◽  
David G Thomas ◽  
Fanjaniaina Fawbush ◽  
...  
Keyword(s):  
Low Income ◽  
Complementary Feeding ◽  
Dietary Diversity ◽  
Feeding Practices ◽  
Child Growth ◽  
Maternal Knowledge ◽  
Complementary Foods ◽  
Child Feeding ◽  
Attitudes And Practices ◽  
Child Undernutrition

ABSTRACT Background Data are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar. Objectives This study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6–23 mo in the Vakinankaratra region of Madagascar. Methods Knowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than −2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach. Results Maternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers’ workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding. Conclusions Integrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.

scholarly journals Effect of an Integrated Package of Nutrition Behavior Change Interventions on Infant and Young Child Feeding Practices and Child Growth from Birth to 18 Months: Cohort Evaluation of the Baduta Cluster Randomized Controlled Trial in East Java, Indonesia

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3851
Author(s):  
Umi Fahmida ◽  
Min Kyaw Htet ◽  
Elaine Ferguson ◽  
Tran Thanh Do ◽  
Annas Buanasita ◽  
...  
Keyword(s):  
Young Child ◽  
Dietary Diversity ◽  
Age Groups ◽  
Intervention Group ◽  
Feeding Practices ◽  
Child Growth ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Behavior Change Interventions ◽  
Infant And Young Child

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project’s effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2–5.5) and 2.79 (95% CI: 1.7–4.4) for DDS and 3.49 (95% CI: 2.2–5.5) and 2.74 (95% CI: 1.8–5.2) for MAD in the 9–11 month and 16–18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age.

scholarly journals Dietary Diversity Measures Derived from Food Frequency Methods Are Weak Proxies for Anthropometric Indicators of Child Nutrition in East Africa (P11-111-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Lucas Gosdin ◽  
Usha Ramakrishnan ◽  
Amy Webb Girard
Keyword(s):  
Child Nutrition ◽  
Dietary Diversity ◽  
Child Feeding ◽  
Middle Income ◽  
Food Frequency ◽  
Anthropometric Indicators ◽  
Young Child Feeding ◽  
Child Undernutrition ◽  
Funding Sources ◽  
Low Middle Income Countries

Abstract Objectives The 7-item child dietary diversity score (DDS) is used widely as a metric of dietary diversity (DD) for infant and young child feeding (IYCF) in low-middle income countries. Validation of the DDS was based on mean micronutrient density adequacy and not other measures of child nutrition. We aimed to develop a measure of DD more strongly associated with anthropometric indicators of child nutrition. Methods We used data from two Tanzanian surveys, IMMANA (n = 88; ages 6–23 mo.) and the Demographic and Health Survey (DHS) (n = 9,156; ages 6–59 mo.), and two Kenyan surveys, MAMA SASHA (n = 384; age 6–12 mo.) and DHS (n = 17,509; ages 6–59 mo.). For each survey, we calculated the DDS, minimum DD, a score using all 15 items found in the standard DHS, and a yes/no indicator of animal source food (ASF) consumption. In IMMANA and MAMA SASHA, we also used a count of all unique food items consumed and based each measure on both 24-hr and 7-day recall periods. Outcome indicators were stunting, wasting, and underweight as defined by WHO. We evaluated the performance of each DD measure in identifying child undernutrition by comparing the area under the ROC curve (AUC), and estimating odds ratios using logistic regression methods. AUC = 50% is no better than random assignment. Complex survey procedures were used in all analyses and alpha was set at 0.05. Results In the DHS and MAMA SASHA data, all measures of DD had similar AUC values that did not exceed 61% when compared to the anthropometric indicators. In the IMMANA data, no measure exceeded 70% AUC for wasting, 64% for underweight, or 58% for stunting. For most DD measures, increasing the recall period to 7 days marginally improved its AUC (< 3%), while it decreased the AUC for wasting in the IMMANA data. The ASF indicator had a similar AUC to the DDS. In the Tanzania DHS, a higher DD, by all four measures, was associated with decreased odds of stunting, wasting, and underweight. In contrast, no measure of DD was associated with growth indicators for Kenya. The DD indicators based on the 15-item list and the count of unique foods were negatively associated with odds of wasting in the IMMANA data. Conclusions In two east African settings, measures of DD derived from existing food frequency questionnaires were weak proxies for measures of child undernutrition based on anthropometry. Funding Sources Innovative Methods and Metrics for Agriculture and Nutrition Actions.

scholarly journals Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 825
Author(s):  
Mansi Dhami ◽  
Felix Ogbo ◽  
Blessing Akombi-Inyang ◽  
Raphael Torome ◽  
Kingsley Agho ◽  
...  
Keyword(s):  
Young Child ◽  
Dietary Diversity ◽  
Meta Analysis ◽  
Bottle Feeding ◽  
Bibliographic Databases ◽  
Child Feeding ◽  
Factors Associated ◽  
Young Child Feeding ◽  
Semi Solid ◽  
One Year

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.

scholarly journals Nutrition Intervention Using Behavioral Change Communication without Additional Material Inputs Increased Expenditures on Key Food Groups in Bangladesh

2020 ◽  
Vol 150 (5) ◽  
pp. 1284-1290
Author(s):  
Andrea M Warren ◽  
Edward A Frongillo ◽  
Phuong H Nguyen ◽  
Purnima Menon
Keyword(s):  
Behavioral Change ◽  
Dietary Diversity ◽  
Nutrition Intervention ◽  
Food Groups ◽  
Child Feeding ◽  
Additional Material ◽  
Change Communication ◽  
Intensive Intervention ◽  
Percentage Points ◽  
Food Expenditures

ABSTRACT Background Behavioral change communication (BCC) promotes skills and knowledge to improve infant and young child feeding, but without additional material inputs, recipients must develop strategies to translate knowledge into action. Using data from the Alive & Thrive initiative in Bangladesh (2010–2014), we aimed to test whether households receiving the intensive intervention (opposed to the nonintensive intervention) increased expenditures on key foods for mothers and children (e.g., foods that were promoted by the intervention and also changed in maternal and child diets). Methods The intensive intervention provided interpersonal counseling, community mobilization, and mass media campaigns to promote breastfeeding and complementary feeding. A cluster-randomized design compared 20 subdistricts randomly assigned to the intensive (4281 households) or nonintensive (4284 households) intervention. Measures included food and nonfood expenditures, dietary diversity, and women's economic resources. Linear and logistic regression tested difference-in-differences (DD) in expenditures and dietary diversity, accounting for subdistricts as clusters, and the association between maternal and child consumption of specific food groups and corresponding food expenditures. Results Expenditures on eggs and flesh foods increased more in intensive areas than in nonintensive areas by 53 (P &lt; 0.01) and 471 (P &lt; 0.01) taka/mo, respectively. Household food expenditures increased more in intensive areas by 832 taka (P = 0.02), whereas changes in nonfood expenditures did not differ. Women's employment and control of income increased more in intensive areas by 12 (P = 0.03) and 13 (P &lt; 0.01) percentage points, respectively, while jewelry ownership decreased more by 23 percentage points (P &lt; 0.01). Higher expenditures on food groups were reflected in higher consumption by women and children. Conclusions Recipients in the intensive intervention mobilized additional resources to improve diets, reflected in increased expenditures and consumption of promoted foods. BCC interventions should document how recipients produce desired results without additional material inputs, particularly for behaviors that likely require additional resources. This trial was registered at clinicaltrials.gov as NCT01678716.

scholarly journals A cross sectional study on optimal infant and young child feeding practices with reference to WHO indicators in a rural area of Puducherry

2019 ◽  
Vol 6 (4) ◽  
pp. 1684
Author(s):  
Arulprasad Radjasegarane ◽  
Anandaraj Rajagopal ◽  
Prakash Mathiyalagen ◽  
Kavita Vasudevan
Keyword(s):  
Young Child ◽  
Dietary Diversity ◽  
Feeding Practices ◽  
Cross Sectional Study ◽  
Child Feeding ◽  
Cross Sectional ◽  
Young Child Feeding ◽  
Child Feeding Practices ◽  
Infant And Young Child ◽  
One Year

Background: Optimal infant and young child feeding practices (IYCF) are essential to address the increasing burden of malnutrition and for the overall development of the children. The present study was conducted to estimate the proportion of optimal infant and young child feeding practices among rural children aged 0 to 23 months and study the associated socio demographic factors.Methods: A community based cross-sectional study was conducted among 360 children in the age group of 0 to 23 months in a rural field practice area of a medical college in Puducherry. Data on IYCF practices were collected using a standardized tool developed by WHO. Core and optional IYCF indicators were calculated. Chi-square test and Fishers’ exact test were used as tests of significance.Results: Almost 88.0% of infants were initiated early on breastfeeding and 90.8% were exclusively breastfed for six months. Children who were continuously breastfed at one year and two years were 77.4% and 22.4% respectively. About 75.0% were introduced with solid or semisolid foods at 6 to 8 months of age. Among children aged 6 to 23 months, 77.3% had the recommended minimum dietary diversity, 81.3% had the minimum meal frequencies, while 57.7% received the minimum acceptable diet and only 39.4% consumed iron rich foods. Gender was significantly associated with the practice of continued breastfeeding at one year, adequate minimum dietary diversity and minimum meal frequency.Conclusions: The core and optional IYCF indicators were acceptably good in the initial six months of life but thereafter showed suboptimal levels, which should be emphasized among the mothers or primary care givers.

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).

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