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Delbiso TD, Nigatu YD, Tilahun N. Early childhood development and nutritional status in urban Ethiopia. MATERNAL & CHILD NUTRITION 2024; 20:e13638. [PMID: 38450957 PMCID: PMC11168352 DOI: 10.1111/mcn.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
Early childhood development (ECD) is crucial for better health and well-being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem-solving and personal-social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community-based cross-sectional survey design, 627 mother-child (12-36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem-solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non-stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition.
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Affiliation(s)
- Tefera Darge Delbiso
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Yakob Desalegn Nigatu
- Department of Nutrition and Dietetics, School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
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Khanam SJ, Khan MN. Examining the influence of child nutritional disorders on early childhood development in Bangladesh: insights from the multiple indicator cluster survey. Public Health Nutr 2024; 27:e76. [PMID: 38384260 DOI: 10.1017/s1368980024000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE The objective of this study was to explore the relationship between various forms of child nutritional disorders and early childhood development in Bangladesh. DESIGN We analysed data from the nationally representative cross-sectional 2019 Multiple Indicator Cluster Survey. Early childhood development was evaluated using the Early Childhood Development Index (ECDI), which comprised 10 yes-or-no questions across four domains: literacy-numeracy, physical well-being, socio-emotional development, and learning abilities. Nutritional disorders (e.g. stunting, wasting, and underweight) were measured based on the World Health Organization's height and weight guidelines. To investigate the relationships between child development and nutritional disorders, we used multilevel logistic regression models. SETTING Bangladesh. PARTICIPANTS Data of 9,455 children aged 3 and 4 years. RESULTS Approximately 38 % of the children analysed experienced a nutritional disorder, with stunting being the most prevalent at 28·15 %. Overall, 25·27 % did not meet expected developmental progress measured by the ECDI. Stunted children were more likely to be off track developmentally, while those without any nutritional disorder were more likely to be on track. Socio-demographic factors, including age, sex, attendance in early childhood education programme, maternal education, maternal functional difficulties, region, and income, were identified as determinants of ECDI. CONCLUSIONS Childhood nutrition and socio-demographic factors significantly affect multiple developmental domains and overall ECDI among children aged 3-4 years. Prioritising policies and programmes that improve nutrition and address these determinants are crucial for fostering optimal development in children.
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Affiliation(s)
- Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
- Centre for Women's Health Research, Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
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Gelli A, Duchoslav J, Gladstone M, Gilligan D, Katundu M, Maleta K, Quisumbing A, Bliznashka L, Ahun M. Impact evaluation of a maternal and child cash transfer intervention, integrated with nutrition, early childhood development, and agriculture messaging (MAZIKO-IE): a study protocol for a cluster-randomised controlled trial. Trials 2024; 25:46. [PMID: 38218938 PMCID: PMC10790253 DOI: 10.1186/s13063-023-07782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 11/06/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Children in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program. METHODS We designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status. DISCUSSION This is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes. TRIAL REGISTRATION ISRCTN ISRCTN53055824. Registered on 7 March 2022.
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Upadhyay RP, Taneja S, Strand TA, Hysing M, Koshy B, Bhandari N, Bahl R. Milk-cereal mix supplementation during infancy and impact on neurodevelopmental outcomes at 12 and 24 months of age: a randomised controlled trial in India. Br J Nutr 2023; 130:868-877. [PMID: 36539339 PMCID: PMC10404480 DOI: 10.1017/s0007114522003944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
Inadequate protein intake and lack of micronutrients may affect neurodevelopment in infants. This randomised controlled trial was conducted to measure the effect of two milk-cereal mixes with modest and high amounts of protein and enriched with multiple micronutrients, given between 6 and 12 months, on cognitive, language, motor and behavioural scores at 12 and 24 months of age, compared with no-supplementation. The two supplements were also compared with each other. The study was conducted in urban Delhi, India, and the infants were randomised in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared with no-supplement group, an increase in the motor scores (mean difference, MD 1·52, 95 % CI: 0·28, 2·75) and a decrease in the infant temperament scores (MD - 2·76, 95 % CI: -4·23, -1·29) in the modest-protein group was observed. Those in the high-protein group had lower socio-emotional scores (MD - 1·40, 95 % CI: -2·43, -0·37) and higher scores on Infant Temperament Scale (MD 2·05, 95 % CI: 0·62, 3·48) when compared with modest-protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. In conclusion, supplementation with modest amount of protein and multiple micronutrients may lead to short-term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observed.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tor Arne Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Beena Koshy
- Department of Developmental Pediatrics, Christian Medical College, Vellore, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Wang KW, Ling ZJ, Yuan Z, Zhang J, Yi SJ, Xiong YW, Chang W, Lin ZJ, Zhu HL, Yang L, Wang H. The Long-Term Effect of Maternal Iron Levels in the Second Trimester on Mild Thinness among Preschoolers: The Modifying Effect of Small for Gestational Age. Nutrients 2023; 15:3939. [PMID: 37764723 PMCID: PMC10535896 DOI: 10.3390/nu15183939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The supplementation of multiple micronutrients throughout pregnancy can reduce the risk of adverse birth outcomes and various diseases in children. However, the long-term effect of maternal multiple micronutrient levels in the second trimester on the overall development of preschoolers remains unknown. Therefore, 1017 singleton mother-infant pairs and 6-year-old preschoolers were recruited based on the China-Wuxi Birth Cohort Study. Meanwhile, information on the demographic characteristics of pregnant women and preschoolers, maternal copper, calcium, iron, magnesium, and zinc levels in whole blood during the second trimester, and neonatal outcomes, were collected. We aimed to investigate the long-term impact of maternal copper, calcium, iron, magnesium, and zinc levels in the second trimester on mild thinness among 6-year-old preschoolers, and the modifying effect of small for gestational age (SGA), within the Chinese population. Multiple logistic regression models revealed that high-level maternal iron in the second trimester reduced the risk of mild thinness [adjusted OR: 0.46 (95% CI: 0.26, 0.80)] among 6-year-old preschoolers. However, no significant association was found for the remaining four maternal essential metal elements. Additionally, the restricted cubic spline function showed that the risk of mild thinness decreased when maternal iron concentration exceeded 7.47 mmol/L in whole blood during the second trimester. Furthermore, subgroup analysis indicated that the long-term protective effect of high-level maternal iron on mild thinness was only observed in SGA infants. Summarily, high-level maternal iron in the second trimester distinctly lowers the risk of mild thinness among 6-year-old preschoolers, especially in preschoolers with birth outcomes of SGA. Our findings offer evidence for the implementation of iron supplementation in the second trimester as a preventive measure against mild thinness in children.
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Affiliation(s)
- Kai-Wen Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Zheng-Jia Ling
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
- Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, Wuxi 214002, China
| | - Zhi Yuan
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Jin Zhang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Song-Jia Yi
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Yong-Wei Xiong
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Wei Chang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Zhi-Jing Lin
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Hua-Long Zhu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Lan Yang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, Wuxi 214002, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
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Weigel MM, Armijos RX. Association of household food insecurity with developmental delay in preschool children: 2018 Ecuadorian Nutrition and Health National Survey. J Nutr Sci 2023; 12:e89. [PMID: 37587973 PMCID: PMC10425761 DOI: 10.1017/jns.2023.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023] Open
Abstract
We investigated the association of household food insecurity (HFI) with developmental delays in 36-59-month-old preschool children (n 7005) using cross-sectional data from the 2018 Ecuadorian National Health and Nutrition Survey. HFI was assessed with the Food Insecurity Experience Scale and developmental delays with the Early Childhood Development Index. Log-binomial regression models estimated the association of HFI with global (overall) developmental delay (GDD) and delays in four individual developmental domains, adjusting for covariates. Nearly half of the children lived in households with marginal (24⋅5 %) or moderate-severe HFI (21⋅7 %). Eighteen percent were identified with GDD. Delays in the individual domains of literacy-numeracy, social-emotional, physical and cognitive development were identified for 64, 21⋅5, 3⋅3 and 3⋅1 %, respectively. GDD was more likely among preschool children from households with marginal (aPR = 1⋅29; 95 % C.I. = 1⋅10, 1⋅49) and moderate-severe HFI (aPR = 1⋅30; 95 % C.I. = 1⋅11, 1⋅51). Social-emotional development delays were also more likely among those from households with marginal (aPR = 1⋅36; 95 % C.I. = 1⋅19, 1⋅56) and moderate-severe HFI (aPR = 1⋅33; 95 % C.I. = 1⋅15, 1⋅54) different from the other three domains. Several other potentially modifiable risk (violent discipline, maternal depressive symptoms) and protective factors (adequate child stimulation, higher maternal education, handwashing with soap/detergent) were also independently associated with GDD and/or literacy-numeracy and cognitive delays. Our findings suggest that HFI is an independent risk factor for GDD and social-emotional developmental delays in Ecuadorian preschoolers. They underscore the importance of strengthening and expanding poverty reduction, food security and early childhood development policies and interventions to improve the opportunities for children to achieve their full developmental potential.
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Affiliation(s)
- M. Margaret Weigel
- Department of Environmental & Occupational Health, Indiana University Bloomington, Bloomington, IN, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, IN, USA
- Center for Latin American and Caribbean Studies, Indiana University, Bloomington, IN, USA
- Indiana University Center for Global Health Equity, Indianapolis, IN, USA
| | - Rodrigo X. Armijos
- Department of Environmental & Occupational Health, Indiana University Bloomington, Bloomington, IN, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, IN, USA
- Center for Latin American and Caribbean Studies, Indiana University, Bloomington, IN, USA
- Indiana University Center for Global Health Equity, Indianapolis, IN, USA
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Hentschel E, Tomlinson H, Hasan A, Yousafzai A, Ansari A, Tahir-Chowdhry M, Zamand M. Risks to Child Development and School Readiness Among Children Under Six in Pakistan: Findings from a Nationally Representative Phone Survey. INTERNATIONAL JOURNAL OF EARLY CHILDHOOD = REVUE INTERNATIONALE DE L'ENFANCE PRESCOLAIRE = REVISTA INTERNACIONAL DE LA INFANCIA PRE-ESCOLAR 2023:1-39. [PMID: 37360191 PMCID: PMC9994389 DOI: 10.1007/s13158-023-00353-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 06/28/2023]
Abstract
This paper analyzes the risks to child development and school readiness among children under age 6 in Pakistan. Drawing on a nationally representative telephone survey conducted in the midst of a global pandemic, between December 2021 and February 2022, we present the first nationally representative estimates of child development for children under 3 years of age and school readiness for children 3-6 years of age, using internationally validated instruments. The paper examines how risk factors that were exacerbated due to the COVID-19 pandemic, such as parental distress, lack of psychosocial stimulation, food insecurity, low maternal education, no enrollment in early childhood education, and living in a rural area, are associated with children's outcomes. The data indicate that more than half (57 percent) of parents with children under age 3 were distressed and that 61 percent of households reported cutting down on the size of or skipping meals since the start of the pandemic. The data reveal that over half of parents fail to engage in adequate psychosocial stimulation with their child and enrollment in early childhood education is very low (39 percent). The paper finds that child development outcomes decline rapidly as the number of risks increase. Specifically, for children under 3 years, lack of psychosocial stimulation at home and higher levels of parental distress were most significantly associated with lower child development levels. For a child aged 3-6 years, early childhood education enrollment and the amount of psychosocial stimulation the child received at home had the strongest association with school readiness scores.
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Affiliation(s)
- Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
- Education Global Practice, World Bank, Washington, USA
| | | | - Amer Hasan
- Education Global Practice, World Bank, Washington, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Amna Ansari
- Education Global Practice, World Bank, Washington, USA
| | | | - Mina Zamand
- Education Global Practice, World Bank, Washington, USA
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Tran LM, Nguyen PH, Young MF, Ramakrishnan U, Alderman H. Home environment and nutritional status mitigate the wealth gap in child development: a longitudinal study in Vietnam. BMC Public Health 2023; 23:286. [PMID: 36755279 PMCID: PMC9906900 DOI: 10.1186/s12889-023-15156-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Inequity in child development is found at early age, but limited evidence exists on whether these gaps change over time and what are the mediators. OBJECTIVE We aim to (1) quantify wealth related gaps in cognitive and socio-emotional development in early and middle childhood; (2) examine how these gaps were mitigated by maternal, child factors and home environment. METHODS We assessed the offspring of women who participated in a randomized controlled trial of preconception micronutrient supplementation in Vietnam (n = 1599). Child development was measured by the Bayley Scales of Infant Development-III (at 1-2y) and the Wechsler Intelligence Scale for Children®-IV (at 6-7y). We used multivariable regression to estimate the changes in wealth gaps for child development over time, adjusting for potential factors that potentially influence cognitive development. RESULTS We found significant wealth gaps in cognitive development during early childhood (gaps between top and bottom quintiles: 0.5 SD); these gaps increased substantially in middle childhood (0.9 SD). Wealth disparity in social emotion did not change over time (0.26-0.28 SD). Maternal factors, quality of home environment, and child nutritional status mitigated the wealth gap in cognitive development (7-42%) in early childhood. The contribution of these mitigating factors was smaller in middle childhood (2- 15%). Wealth gap in social emotion reduced by 13% and 43% among children with better nutritional status at 2y and higher quality of home environment at 6-7y, respectively. CONCLUSION Interventions focusing on improving quality of home environment, maternal education, wellbeing, and child nutrition status may help reduce developmental deficits associated with poverty.
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Affiliation(s)
- Lan Mai Tran
- grid.189967.80000 0001 0941 6502Emory University, Atlanta, GA USA
| | - Phuong Hong Nguyen
- International Food Policy Research Institute (IFPRI), 1201 I Street, 20001, Washington, NW, DC, USA. .,Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
| | - Melissa F. Young
- grid.189967.80000 0001 0941 6502Emory University, Atlanta, GA USA
| | | | - Harold Alderman
- grid.419346.d0000 0004 0480 4882International Food Policy Research Institute (IFPRI), 1201 I Street, 20001 Washington, NW, DC USA
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Desmond C, Watt K, Boua PR, Moore C, Erzse A, Sorgho H, Hofman K, Roumba T, Tinto H, Ward KA. Investing in human development and building state resilience in fragile contexts: A case study of early nutrition investments in Burkina Faso. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001737. [PMID: 36989221 DOI: 10.1371/journal.pgph.0001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023]
Abstract
Maternal and early malnutrition have negative health and developmental impacts over the life-course. Consequently, early nutrition support can provide significant benefits into later life, provided the later life contexts allow. This study examines the limits of siloed investments in nutrition and illustrates how ignoring life-course contextual constraints limits human development benefits and exacerbates inequality, particularly in fragile contexts. This case study focuses on Burkina Faso, a country with high rates of early malnutrition and a fragile state. We modelled the impact of scaling up 10 nutrition interventions to 80% coverage for a single year cohort on stunting, nationally and sub-nationally, using the Lives Saved Tool (LiST), and the consequent impact on earnings, without and with a complementary cash-transfer in later life. The impact on earnings was modelled utilising the well-established pathway between early nutrition, years of completed schooling and, consequent adult earnings. Productivity returns were estimated as the present value of increased income over individuals' working lives, then compared to estimates of the present value of providing the cost of nutrition interventions and cash-transfers. The cost benefit ratio at the national level for scaled nutrition alone is 1:1. Sub-nationally the worst-off region yields the lowest ratio < 0.2 for every dollar spent. The combination of nutrition and cash-transfers national cost benefit is 1:12, still with regional variation but with great improvement in the poorest region. This study shows that early nutrition support alone may not be enough to address inequality and may add to state fragility. Taking a life-course perspective when priority-setting in contexts with multiple constraints on development can help to identify interventions that maximizing returns, without worsening inequality.
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Affiliation(s)
- Chris Desmond
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kathryn Watt
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Palwendé R Boua
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
- Sydney Brenner Institute for Molecular Biosciences (SBIMB), University of Witwatersrand, Johannesburg, South Africa
| | - Candice Moore
- Department of International Relations, School of Social Sciences, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Karen Hofman
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Toussaint Roumba
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro (CRUN), Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Kate A Ward
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
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Meyer SC, Montez K, McClung R, Michael L, Namak S, Brown CL. Growth of Pediatric Refugees after Resettlement to the Southeastern United States. Acad Pediatr 2022; 22:777-781. [PMID: 34637931 PMCID: PMC8993936 DOI: 10.1016/j.acap.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare weight status and body mass index z-scores (BMIz) of refugee children upon arrival to the Southeastern US and after resettlement with age- and sex-matched controls of nonrefugee children. METHODS We identified refugee children resettled between July 2014 and June 2018 to Forsyth County, NC. Refugees were assigned age- and sex-matched controls (3 controls:1 refugee) who received care at the same health care site, were Medicaid insured, and had height and weight recorded at time of their matched refugee's resettlement plus at least 2 additional visits. BMI and BMIz were calculated. Pearson chi-square test assessed differences in weight status at the time of refugee resettlement and at the last measured time point. Multilevel linear mixed-effects regression models assessed change in BMIz by refugee status, adjusting for sex, race/ethnicity, age, and time since resettlement. RESULTS This study examined 139 pediatric refugees and 417 nonrefugee controls; 46% were female. At the time of resettlement, refugees had a higher rate of underweight (3.3% vs 1.9%), higher rate of healthy weight (68.9% vs 48.2%), and lower rate of overweight/obesity (27.8% vs 50%), compared to controls P < .001. At the last available time point, compared to controls, refugees had higher rates of underweight (3.3% vs 3.0%) and healthy weight (69.5% vs 54.2%) and lower rates of overweight/obesity (27.2% vs 42.7%), P = .005. Refugees had a lower predicted BMIz compared with controls (adjusted β: -0.78; 95% confidence interval -0.91, -0.66). CONCLUSIONS Resettled pediatric refugees were found to have significantly lower predicted BMIz than their age- and sex-matched nonrefugee controls.
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Affiliation(s)
- Stephanie C Meyer
- Department of Student Affairs (SC Meyer), Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (K Montez and CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Rachel McClung
- Novant Health, Robinhood Pediatrics (R McClung), Winston-Salem, NC
| | - Lemaat Michael
- Department of Student Affairs (L Michael), Wake Forest School of Medicine, Winston-Salem, NC
| | - Shahla Namak
- Department of Family and Community Medicine (S Namak), Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics (K Montez and CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC; Department of Epidemiology and Prevention (CL Brown), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC.
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11
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Translation, Cultural Adaptation, Reliability, and Validity Evidence of the Feeding/Swallowing Impact Survey (FS-IS) to Brazilian Portuguese. Dysphagia 2021; 37:1226-1237. [PMID: 34779911 DOI: 10.1007/s00455-021-10383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to translate and adapt the Feeding/Swallowing Impact Survey (FS-IS) into Brazilian Portuguese and provide a validated instrument for caregivers of children with feeding/swallowing disorders. This cross-cultural study involved initial translation, synthesis of translations, back-translation, Committee of Experts, and pre-test. The sample consisted of 95 primary caregivers of children with feeding/swallowing disorders classified by Pediatric Dysphagia Evaluation Protocol (PDEP) in mild (n = 9), moderate-severe (n = 40), or profound (n = 46) dysphagia. Reliability and evidence of validity based on test content, response processes, internal structure and the relations to other variables were investigated. Internal consistency, test-retest, exploratory and confirmatory factor analysis were performed, in addition to the correlation with PedsQL™ Family Impact Module (PedsQLTMFIM). The pre-test participants did not report any difficulties in understanding the translated version. The Brazilian Portuguese version of FS-IS (Pt-Br-FS-IS) presented Cronbach's Alpha of 0.83, Exploratory Factor Analysis verified that the instrument would not be unifactorial (KMO = 0.74 and Bartlett's sphericity test p < 0.001) and Confirmatory Factor Analysis confirmed the original model in three subscales with χ2/df = 1.23, CFI = 0.92, TLI = 0.90, RMSEA (90% CI) 0.049 (0.011-0.073) adjustment indexes and the ICC was excellent in all subscales and total score. The correlation with PedsQL™FIM was significant in the total score and subscales. This study successfully translated and cross-culturally adapted the FS-IS instrument to the Brazilian Portuguese language and the investigation of its reliability and validity evidence suggests that the Pt-Br-FS-IS is a reliable and valid tool to measure the impact of feeding/swallowing disorders on the quality of life of caregivers of affected children.
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Siraneh Y, Woldie M, Birhanu Z. Effectiveness of Positive Deviance Approach to Promote Exclusive Breastfeeding Practice: A Cluster Randomized Controlled Trial. Risk Manag Healthc Policy 2021; 14:3483-3503. [PMID: 34466041 PMCID: PMC8403074 DOI: 10.2147/rmhp.s324762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Suboptimal breastfeeding (BF) contributes to a significant number of infant deaths. A positive deviance approach (PDA) was not studied in Ethiopia, whether it improve exclusive breastfeeding (EBF) practice. Therefore, we determined the effectiveness of positive deviant approached intervention in increasing the proportion of EBF practice. Methods A cluster-randomized controlled trial was employed in Jimma town from February 01 to September 30, 2018. Six randomly selected clusters (kebeles) were randomized into two arms. Then, 260 mothers who met the eligibility criteria were enrolled in either the intervention or control arm depending on where they lived. Women in the intervention group received counseling and social support in addition to the usual service to promote EBF, from women identified and trained as positive deviants in their community, while those in the control groups received the usual community-based services from urban health extension professionals. Data on primary and secondary outcome variables were collected at three points, and statistical difference was estimated using Chi-X2 or Fisher exact test. The net effect of the intervention was calculated. The magnitude of the intervention effect was estimated using the relative risk. For all statistical tests, 95% CI with a P-value of <0.05 was used. Results The overall response rate at the endline was 98.8%. Exclusive BF was significantly different between the groups at mid and end points, while no difference at baseline. A higher proportion of mothers in the intervention group reported EBF compared to the control group at mid and end-line. The rate of EBF increased by 18.5% (P=0.01) in the intervention group while 0.2% in the counterparts, with a net effect of +18.2%. The probability of practicing EBF was significantly higher for the intervention group compared to the control group. At baseline, the relative risk of avoiding EBF (RR:1.112) was similar among the two groups. However, at follow-up, mothers in the intervention group were 2 times more likely to practice EBF (RR: 2.294) compared to those in the control group. Conclusion and Recommendation The PD approach is an effective intervention to promote EBF and also positively affected frequency and duration of BF. Therefore, we recommend the promotion and use of positive deviance approach as a strategy to improve EBF practice in urban settings. Trial Registration Number Clinical trial PACTR201805003379263, 23 May 2018.
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Affiliation(s)
- Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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13
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Economic evaluation of an early childhood development center–based agriculture and nutrition intervention in Malawi. Food Secur 2021; 14:67-80. [PMID: 35222745 PMCID: PMC8858302 DOI: 10.1007/s12571-021-01203-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/16/2021] [Indexed: 11/21/2022]
Abstract
Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.
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14
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Dulal S, Prost A, Karki S, Saville N, Merom D. Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003872. [PMID: 34321232 PMCID: PMC8319976 DOI: 10.1136/bmjgh-2020-003872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Around 250 million children in low-income and middle-income countries are at risk of not fulfilling their developmental potential. There is a need to update syntheses investigating the effects of combined nutrition and stimulation interventions on children’s growth and development and identify intervention characteristics associated with positive effects. Methods We did a systematic review to: (1) understand the effects of integrated nutrition and stimulation interventions versus (i) usual care and (ii) standalone nutrition or stimulation interventions, on the growth and development of children under five; (2) explore intervention characteristics (delivery strategies, behaviour change techniques, intensity and personnel) associated with positive effects. We searched eight databases for studies published from inception to 16 November 2020. Eligible studies were randomised and non-randomised controlled trials of integrated nutrition and stimulation interventions examining growth and developmental outcomes. We performed meta-analyses for length-for-age/height-for-age, weight-for-age and weight-for-length/weight-for-height Z scores and cognitive, motor and language development scores, and subgroup analyses by intervention characteristics. We conducted random-effects metaregression to assess potential subgroup differences in outcomes by intervention characteristics. Results Twenty trials were included in the meta-analysis. Pooled effect sizes showed significant benefits of integrated interventions on developmental outcomes compared with usual care and standalone nutrition interventions (I2 >75%) but not on growth outcomes. Moreover, integrated interventions have non-significant effects on developmental outcomes compared with standalone stimulation interventions. Integrated interventions showed greater effects on cognitive (p=0.039) and language (p=0.040) outcomes for undernourished children compared with adequately nourished children. The effects of integrated interventions on developmental outcomes did not differ by intervention characteristics. Conclusion Integrated interventions have greater benefits for children’s development than usual care or standalone nutrition interventions, especially in settings with high levels of undernutrition. Future studies should use standardised reporting of implementation processes to identify intervention characteristics linked to positive effects.
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Affiliation(s)
- Sophiya Dulal
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Surendra Karki
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Research and Development, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Alexandria, New South Wales, Australia
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
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15
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Poveda NE, Hartwig FP, Victora CG, Adair LS, Barros FC, Bhargava SK, Horta BL, Lee NR, Martorell R, Mazariegos M, Menezes AMB, Norris SA, Richter LM, Sachdev HS, Stein A, Wehrmeister FC, Stein AD. Patterns of Growth in Childhood in Relation to Adult Schooling Attainment and Intelligence Quotient in 6 Birth Cohorts in Low- and Middle-Income Countries: Evidence from the Consortium of Health-Oriented Research in Transitioning Societies (COHORTS). J Nutr 2021; 151:2342-2352. [PMID: 33982126 PMCID: PMC8436131 DOI: 10.1093/jn/nxab096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/18/2021] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growth faltering has been associated with poor intellectual performance. The relative strengths of associations between growth in early and in later childhood remain underexplored. OBJECTIVES We examined the association between growth in childhood and adult human capital in 5 low- and middle-income countries (LMICs). METHODS We analyzed data from 9503 participants in 6 prospective birth cohorts from 5 LMICs (Brazil, Guatemala, India, the Philippines, and South Africa). We used linear and quasi-Poisson regression models to assess the associations between measures of height and relative weight at 4 age intervals [birth, age ∼2 y, midchildhood (MC), adulthood] and 2 dimensions of adult human capital [schooling attainment and Intelligence Quotient (IQ)]. RESULTS Meta-analysis of site- and sex-specific estimates showed statistically significant associations between size at birth and height at ∼2 y and the 2 outcomes (P < 0.001). Weight and length at birth and linear growth from birth to ∼2 y of age (1 z-score difference) were positively associated with schooling attainment (β: 0.13; 95% CI: 0.08, 0.19, β: 0.17; 95% CI: 0.07, 0.32, and β: 0.25, 95% CI: 0.10, 0.40, respectively) and adult IQ (β: 0.74, 95% CI: 0.35, 1.14, β: 0.73, 95% CI: 0.35, 1.10, and β: 1.52, 95% CI: 0.96, 2.08, respectively). Linear growth from age 2 y to MC and from MC to adulthood was not associated with higher school attainment or IQ. Change in relative weight in early childhood, MC, and adulthood was not associated with either outcome. CONCLUSIONS Linear growth in the first 1000 d is a predictor of schooling attainment and IQ in adulthood in LMICs. Linear growth in later periods was not associated with either of these outcomes. Changes in relative weight across the life course were not associated with schooling and IQ in adulthood.
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Affiliation(s)
- Natalia E Poveda
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernando C Barros
- Postgraduate Program in Health and Behaviour, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Santosh K Bhargava
- Consultant Pediatrician and Founder New Delhi Birth Cohort, New Delhi, India
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Nanette R Lee
- USC-Office of Population Studies Foundation, Inc, University of San Carlos – TC, Talamban, Cebu City, Cebu, Philippines
| | - Reynaldo Martorell
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa,Global Health Research Institute, School of Human Development and Health & NIHR Southampton Biomedical Research Centre, University of Southampton, United Kingdom
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Harshpal Singh Sachdev
- Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Alan Stein
- Department of Psychiatr, University of Oxford, Oxford, United Kingdom,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Margolies A, Gelli A, Daryanani R, Twalibu A, Levin C. When Communities Pull Their Weight: The Economic Costs of an Integrated Agriculture and Nutrition Home-Grown Preschool Meal Intervention in Malawi. Food Nutr Bull 2021; 42:3-22. [PMID: 33878905 PMCID: PMC8129463 DOI: 10.1177/0379572120986693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Community-based preschool meals can provide an effective platform for implementing integrated agriculture and nutrition programs. However, there is little evidence on the costs and cost-efficiency of implementing these types of multisectoral interventions. Objectives: Assess the economic costs and cost-efficiency of implementing an effective integrated nutrition-sensitive intervention through a preschool platform in Malawi, including community-level contributions. Methods: The Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) framework and methods were applied to assess financial and economic costs of the intervention. A mixed-methods approach was used to measure and allocate costs for program activities and inputs using financial expenditure data combined with micro-costing. All costs were allocated to input and expenditure categories using the SEEMS-Nutrition framework. To facilitate comparisons with existing school meals programs, activities were also mapped against a standardized school feeding supply chain framework. Results: The total annualized cost of the program was US$197 377, inclusive of both financial and economic costs. The annual economic cost of the program ranged from US$160 per preschool child to US$41 per beneficiary. The principal drivers of cost by program activity were training (46%), school meals provision (19%), monitoring and evaluation (12%), and establishing and running community groups (6.5%). Notably, community contributions accounted for 25% and were driven by food donations and volunteer labor. Conclusions: Cost per beneficiary estimates of implementing an integrated agriculture–nutrition intervention through an early childhood development platform compare favorably with similar interventions. Further research is needed that applies a standardized economic evaluation framework to such multisectoral interventions.
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Affiliation(s)
- Amy Margolies
- 8357International Food Policy Research Institute, Washington, DC, USA
| | - Aulo Gelli
- 8357International Food Policy Research Institute, Washington, DC, USA
| | - Roshan Daryanani
- 8357International Food Policy Research Institute, Washington, DC, USA
| | - Aisha Twalibu
- 8357International Food Policy Research Institute, Washington, DC, USA
| | - Carol Levin
- Department of Global Health, 7284University of Washington, Seattle, WA, USA
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17
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Nutrition, Cognition, and Social Emotion among Preschoolers in Poor, Rural Areas of South Central China: Status and Correlates. Nutrients 2021; 13:nu13041322. [PMID: 33923756 PMCID: PMC8074246 DOI: 10.3390/nu13041322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
Existing empirical evidence suggests that the prevalence of undernutrition in remote and poor, rural areas is still high among Chinese children. While evidence reveals that undernutrition may detrimentally affect child development, studies focusing on rural Chinese preschoolers are sparse. Using the baseline survey of a preschool's free nutritious lunch pilot program, this study examined the relationship between child undernutrition and developmental outcomes among a preschool-aged sample in poor, rural areas of China. We conducted the baseline survey in Hunan province in south central China in September 2018. A total of 1293 preschoolers living in two (then) nationally designated poverty counties in rural Hunan served as our study sample. Children's nutritional statuses were measured using height-for-age z-score, weight-for-age z-score, and anemia, while their cognitive and socio-emotional skills were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and Strengths and Difficulties Questionnaire (SDQ), respectively. We find that 33% of sample preschoolers were anemic, whereas the incidences of stunting and wasting were 11% and 2%, respectively. About 54% of the sample children had delay in at least one of the developmental domains measured in this study. Our findings provide suggestive evidence supporting that children from certain backgrounds tend to experience worse nutritional and developmental outcomes than their counterparts. After controlling for socioeconomic status, we observed that both anemia and stunting were negatively associated with children's cognitive performance; however, they were not associated with socio-emotional performance. As such, this study suggests that free lunch programs have the potential to change children's developmental trajectory in preschool. We believe that our results will contribute to the debate surrounding whether the nutritious lunch program in China should be expanded to the preschool education level.
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18
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Desmond C, Erzse A, Watt K, Ward K, Newell ML, Hofman K. Realising the potential human development returns to investing in early and maternal nutrition: The importance of identifying and addressing constraints over the life course. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000021. [PMID: 36962074 PMCID: PMC10022083 DOI: 10.1371/journal.pgph.0000021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
The benefits of interventions which improve early nutrition are well recognised. These benefits, however, only accrue to the extent that later life circumstances allow. Consequently, in adverse contexts many of the benefits will never be realised, particularly for the most vulnerable, exacerbating inequality. Returns to investment in early nutrition could be improved if we identified contextual factors constraining their realisation and interventions to weaken these. We estimate cost and impact of scaling 10 nutrition interventions for a cohort of South African children born in 2021. We estimate associated declines in malnutrition and mortality, and improvements in years of schooling and future earnings. To examine the role of context over the life-course we estimate benefits with and without additional improvements in school quality and employment opportunities by socio-economic quintile. Scale up reduces national stunting (height for age < = -2SD) rates among children at 24 months by 3.18 percentage points, implying an increase in mean height for age z-score (HAZ) of 0.10, and 53,000 years of additional schooling. Quintile 1 (the poorest) displays the largest decline in stunting, and largest increase in mean HAZ. Estimated total cost of increasing coverage of the interventions for the cohort is US$90 million. The present value of the additional years of schooling is estimated at close to US$2 billion. Cost-benefit ratios suggest the highest return occurs in quintile 5 (1:23). Reducing inequality in school quality closes the gap between quintile 5 and the lower quintiles. If school quality and labour force participation were equal the highest returns are in quintile 1(1:31). An enabling environment is key to maximising human development returns from investing in early nutrition, and to avoid exacerbating existing inequality. Therefore, particularly for children in adverse conditions, it is essential to identify and implement complementary interventions over the life course.
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Affiliation(s)
- Chris Desmond
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Agnes Erzse
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kathryn Watt
- Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Kate Ward
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Marie-Louise Newell
- Faculty of Medicine, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Karen Hofman
- Faculty of Health Sciences, SAMRC/Wits Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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19
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Van Der Straeten D, Bhullar NK, De Steur H, Gruissem W, MacKenzie D, Pfeiffer W, Qaim M, Slamet-Loedin I, Strobbe S, Tohme J, Trijatmiko KR, Vanderschuren H, Van Montagu M, Zhang C, Bouis H. Multiplying the efficiency and impact of biofortification through metabolic engineering. Nat Commun 2020; 11:5203. [PMID: 33060603 PMCID: PMC7567076 DOI: 10.1038/s41467-020-19020-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
Ending all forms of hunger by 2030, as set forward in the UN-Sustainable Development Goal 2 (UN-SDG2), is a daunting but essential task, given the limited timeline ahead and the negative global health and socio-economic impact of hunger. Malnutrition or hidden hunger due to micronutrient deficiencies affects about one third of the world population and severely jeopardizes economic development. Staple crop biofortification through gene stacking, using a rational combination of conventional breeding and metabolic engineering strategies, should enable a leap forward within the coming decade. A number of specific actions and policy interventions are proposed to reach this goal.
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Affiliation(s)
- Dominique Van Der Straeten
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, B-9000, Ghent, Belgium.
| | - Navreet K Bhullar
- Department of Biology, Institute of Molecular Plant Biology, ETH Zurich, Universitaetstrasse 2, 8092, Zurich, Switzerland
| | - Hans De Steur
- Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Wilhelm Gruissem
- Department of Biology, Institute of Molecular Plant Biology, ETH Zurich, Universitaetstrasse 2, 8092, Zurich, Switzerland
- Advanced Plant Biotechnology Center, National Chung Hsing University, Taichung, Taiwan
| | | | | | - Matin Qaim
- Department of Agricultural Economics and Rural Development, University of Goettingen, Platz der Goettinger Sieben 5, 37073, Goettingen, Germany
| | | | - Simon Strobbe
- Laboratory of Functional Plant Biology, Department of Biology, Ghent University, K.L. Ledeganckstraat 35, B-9000, Ghent, Belgium
| | - Joe Tohme
- International Center for Tropical Agriculture, CIAT, Cali, Colombia
| | | | - Hervé Vanderschuren
- Tropical Crop Improvement Lab, Department of Biosystems, KU Leuven, Heverlee, Belgium
- Plant Genetics, TERRA Teaching and Research Center, Gembloux Agro-Biotech, University of Liège, Gembloux, Belgium
| | - Marc Van Montagu
- International Plant Biotechnology Outreach, B-9052, Zwijnaarde, Belgium
| | - Chunyi Zhang
- Biotechnology Research Institute, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Howarth Bouis
- International Food Policy Research Institute, Washington, DC, USA.
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20
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Sincovich A, Gregory T, Zanon C, Santos DD, Lynch J, Brinkman SA. Measuring early child development in low and middle income countries: Investigating the validity of the early Human Capability Index. SSM Popul Health 2020; 11:100613. [PMID: 32637554 PMCID: PMC7327282 DOI: 10.1016/j.ssmph.2020.100613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/18/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022] Open
Abstract
Inclusion of early child development in the United Nations Sustainable Development Agenda raises issues of how this goal should be monitored, particularly in low resource settings. The aim of this paper was to explore the validity of the early Human Capability Index (eHCI); a population measure designed to capture the holistic development of children aged 3-5 years. Convergent, divergent, discriminant and concurrent validity were examined by exploring the associations between eHCI domains and child (sex, age, stunting status, preschool attendance) and family (maternal education, home learning environment) characteristics. Analyses were repeated using data from seven low and middle income countries: Brazil (n = 1810), China (n = 11421), Kiribati (n = 8339), Lao PDR (n = 7493), Samoa (n = 12191), Tonga (n = 6214), and Tuvalu (n = 549). Correlations and linear regressions provide evidence that within these country samples, the tool is capturing the aspects of early child development that it was designed to measure. Although the tool was intended to measure development of children aged 3-5 years, results suggest it can be validly applied to children aged 2-6 years. The eHCI is free, requires minimal implementation resources, captures development across domains and abilities, and is designed to allow cultural and contextual concepts to be included. The eHCI appears psychometrically robust in diverse country contexts and could enable evaluation of early years policies and programs, as well as monitoring of children's development to track progress towards the Sustainable Development Agenda.
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Key Words
- AEDC, Australian Early Development Census
- ASQ, Ages and Stages Questionnaire
- CI, confidence interval
- CREDI, Caregiver Reported Early Development Instrument
- EAP-ECDS, East Asia Pacific Early Child Development Scales
- ECD, early child development
- EDI, Early Development Instrument
- Early child development
- Early human capability index
- IDELA, International Development and Early Learning Assessment
- LMICs, low and middle income countries
- Low and middle income countries
- MICS-ECDI, Multiple Indicator Cluster Survey Early Childhood Development Index
- MODEL, Measure of Development and Early Learning
- PDR, People's Democratic Republic
- Population monitoring
- Program evaluation
- SDG, Sustainable Development Goal
- Sustainable development goals
- eHCI, early Human Capability Index
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Affiliation(s)
- Alanna Sincovich
- School of Public Health, University of Adelaide, Level 9, Adelaide Health and Medical Science Building, 57 North Terrace, Adelaide, South Australia, 5005, Australia
- Telethon Kids Institute, University of Western Australia, Level 15, 31 Flinders St., Adelaide, South Australia, 5000, Australia
| | - Tess Gregory
- School of Public Health, University of Adelaide, Level 9, Adelaide Health and Medical Science Building, 57 North Terrace, Adelaide, South Australia, 5005, Australia
- Telethon Kids Institute, University of Western Australia, Level 15, 31 Flinders St., Adelaide, South Australia, 5000, Australia
| | - Cristian Zanon
- Department of Developmental Psychology and Personality, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2600, Porto Alegre, RS, CEP 90035-003, Brazil
| | - Daniel D. Santos
- Department of Economy, University of São Paulo, Av. Prof. Luciano Gualberto, 908, Butantã, São Paulo, 05508-010, Brazil
| | - John Lynch
- School of Public Health, University of Adelaide, Level 9, Adelaide Health and Medical Science Building, 57 North Terrace, Adelaide, South Australia, 5005, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, United Kingdom
| | - Sally A. Brinkman
- School of Public Health, University of Adelaide, Level 9, Adelaide Health and Medical Science Building, 57 North Terrace, Adelaide, South Australia, 5005, Australia
- Telethon Kids Institute, University of Western Australia, Level 15, 31 Flinders St., Adelaide, South Australia, 5000, Australia
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Botero-Tovar N, Arocha Zuluaga GP, Ramírez Varela A. Factors influencing delivery of intersectoral actions to address infant stunting in Bogotá, Colombia - a mixed methods case study. BMC Public Health 2020; 20:925. [PMID: 32534569 PMCID: PMC7293129 DOI: 10.1186/s12889-020-09057-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
Background Intersectoral actions (ISA) are a recognized relationship between the health sector and other sectors to improve health outcomes. Although a frequent topic in public health studies, evidence for systematic evaluation of implementation of ISA is scarce. An intersectoral health intervention for infants under one-year-old with, and at risk of, stunting (low height-for-age) was developed by a public-private partnership in Bogotá, Colombia, during 2018 and 2019. Here we report a case study conducted in parallel to the intervention designed to assess factors that influenced implementation of the ISA. Methods The case study was developed using a concurrent mixed-methods design, with the qualitative component giving context to the quantitative results. The qualitative component was obtained from four workshops, three focus groups, and 17 semi-structured interviews with actors involved in the intersectoral intervention. The quantitative component was obtained with two questionnaires that evaluated perceptions on improvement and partnership functioning of the ISA. Results This study collected information from 122 participants. The intervention demanded intersectoral collaboration. Political will, motivated human resources, and recognition that health improvement results from collaboration, were factors that facilitated intersectoral actions. Intersectoral actions were limited by difficulties in engaging the health sector, communication challenges related to local health service decentralization, and administrative barriers. Conclusions Intersectoral actions have recently been discussed in the literature due to challenges in implementation and doubts regarding economic outcomes. The implementation of intersectoral public health interventions can be jeopardized by a lack of coordination and management skills.
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Affiliation(s)
- Natalia Botero-Tovar
- Population Health Division, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia.
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Gelli A, Nguyen PH, Santacroce M, Twalibu A, Margolies A, Katundu M. A Community-Based Early Childhood Development Center Platform Promoting Diversified Diets and Food Production Increases the Mean Probability of Adequacy of Intake of Preschoolers in Malawi: A Cluster Randomized Trial. J Nutr 2020; 150:350-355. [PMID: 31616933 DOI: 10.1093/jn/nxz245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/16/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Young children in Malawi consume low-quality diets lacking micronutrients critical for their development. OBJECTIVE To evaluate the impact of an agriculture and nutrition behavior change communication (BCC) intervention implemented through community-based childcare centers on the nutrient adequacy of diets of children living in food-insecure settings in Malawi. METHODS A cluster randomized trial was undertaken in 60 community-based childcare centers, including 1248 children aged 3-6 y. Nutrient intakes were estimated using interactive, multipass 24-h recall. Dietary adequacy was estimated through the probability of adequacy (PA) and mean probability of adequacy (MPA) of 11 micronutrients. Impacts were assessed by difference-in-difference (DID) estimates, adjusted for geographic clustering and child age and sex. RESULTS Intervention groups were similar for most baseline characteristics. Loss to follow-up was low (7% over a 12-mo period) and participation in the intervention was high (>90% enrollment and 80% attendance during the 5 d before the survey). Positive impacts were found for the PA of several individual micronutrient intakes: vitamin A [DID: 9 percentage points (pp), SE 3 pp], vitamin C (14 pp, SE 3 pp), riboflavin (11 pp, SE 3 pp), zinc (8 pp, SE 3 pp), and for the MPA for the 11 nutrients considered (5 pp, SE 1 pp). These impacts were driven by effects on younger children (aged 3-4 y). CONCLUSIONS Using a preschool platform to implement a nutrition-sensitive BCC intervention is an effective strategy to improve the adequacy of micronutrient intake of preschool children in food-insecure settings. The trial was registered at ISCRCTN as ISCRCTN96497560.
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Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Phuong Hong Nguyen
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Marco Santacroce
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Aisha Twalibu
- Save the Children, International/Malawi, Washington, DC, USA/Zomba, Malawi
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Lanigan J, Bailey R, Jackson AMT, Shea V. Child-Centered Nutrition Phrases Plus Repeated Exposure Increase Preschoolers' Consumption of Healthful Foods, but Not Liking or Willingness to Try. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:519-527. [PMID: 31078191 DOI: 10.1016/j.jneb.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine whether the use of child-centered nutrition phrases (CCNP) with repeated exposure (RE) improved willingness to try, liking, and consumption of healthful foods compared with RE alone. DESIGN The researchers used a 2 × 2 × 4 fractionated within-subjects experimental design in the study: phrase condition (RE vs CCNP + RE) by time of measurement (preintervention, postintervention, and 1-month follow-up), by type of food (tomatoes, bell peppers, lentils, and quinoa). SETTING Children were recruited from 2 early education centers; 89% participated. PARTICIPANTS Children aged 3-6 years old (n = 87) who were predominantly white (67%) and from middle-income homes and had parents with some higher education. INTERVENTION Adult delivery of CCNP + RE weekly for 6 weeks. MAIN OUTCOME MEASURE(S) Willingness to try, change in liking, and change in consumption. ANALYSIS Two-level random-effects models were used to account for repeated measurements of willingness to try, liking, and consumption nested within participants. RESULTS Children exhibited greater consumption of CCNP foods at follow-up assessment compared with RE foods (b = -16.28, SE = 5.41, t(528) = 3.01; P = .003). CONCLUSIONS AND IMPLICATIONS Use of CCNP combined with RE may encourage healthy eating, especially for novel foods that children may typically refuse.
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Affiliation(s)
- Jane Lanigan
- Department of Human Development, Washington State University Vancouver, Vancouver, WA.
| | - Rachel Bailey
- School of Communication, Florida State University, Tallahassee, FL
| | | | - Valerie Shea
- Department of Human Development, Washington State University Vancouver, Vancouver, WA
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The long run impact of early childhood deworming on numeracy and literacy: Evidence from Uganda. PLoS Negl Trop Dis 2019; 13:e0007085. [PMID: 30703096 PMCID: PMC6377149 DOI: 10.1371/journal.pntd.0007085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 02/15/2019] [Accepted: 12/17/2018] [Indexed: 12/03/2022] Open
Abstract
Background Up to 1.45 billion people currently suffer from soil transmitted helminth infection, with the largest burden occurring in Africa and Asia. Safe and cost effective deworming treatment exists, but there is a debate about mass distribution of this treatment in high prevalence settings. While the World Health Organization recommends mass administration of anthelmintic drugs for preschool and school-aged children in high (>20%) prevalence settings, and several long run follow up studies of an influential trial have suggested large benefits that persist over time, recent systematic reviews have called this recommendation into question. Methods and findings This paper analyzes the long-term impact of a cluster-randomized trial in eastern Uganda that provided mass deworming treatment to preschool aged children from 2000 to 2003 on the numeracy and literacy skills of children and young adults living in those villages in 2010-2015. This study uses numeracy and literacy data collected seven to twelve years after the end of the deworming trial in a randomly selected subset of communities from the original trial, by an education-focused survey that had no relationship to the deworming study. Building on an earlier working paper which used data from 2010 and 2011 survey rounds, this paper uses an additional four years of numeracy and literacy data (2012, 2013, 2014, and 2015). Aggregating data from all survey rounds, the difference between numeracy scores in treatment versus control communities is 0.07 standard deviations (SD) (95% CI -0.10, 0.24, p = 0.40), the difference in literacy scores is 0.05 SD (95% CI -0.16, 0.27, p = 0.62), and the difference in total scores is 0.07 SD (95% CI -0.11, 0.25, p = 0.44). There are significant differences in program impact by gender, with numeracy and literacy differentially positively affected for girls, and by age, with treatment effects larger for the primary school aged subsample. There are also significant treatment interactions for those living in households with more treatment-eligible children. There is no evidence of differential treatment effects on age at program eligibility or number of years of program eligibility. Conclusions Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion. Point estimates were positive but imprecise; the study lacked sufficient power to rule out substantial positive effects or more modest negative effects. However, there is suggestive evidence that deworming was relatively more beneficial for girls, primary school aged children, and children living in households with other treated children. Research approval As this analysis was conducted on secondary data which is publicly available, no research approval was sought or received. All individual records were anonymized by the data provider prior to public release. Mass deworming is recommended by the World Health Organization for health benefits to communities where soil-transmitted helminth infection is endemic. In addition to health benefits, several recent studies find long run educational or economic benefits for cohorts dewormed as children. In this paper, treatment and control communities which formed part of a cluster randomized deworming trial in eastern Uganda from 2000-2003 were surveyed from 2010-2015 to measure children’s basic numeracy and literacy. We analyze this data to see if there are detectable improvements in basic academic skills among children in the dewormed communities. We find that mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion. However, there is suggestive evidence that deworming is relatively more effective for girls, primary school aged children, and children living in households with other treatment-eligible children.
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Gelli A, Margolies A, Santacroce M, Roschnik N, Twalibu A, Katundu M, Moestue H, Alderman H, Ruel M. Using a Community-Based Early Childhood Development Center as a Platform to Promote Production and Consumption Diversity Increases Children's Dietary Intake and Reduces Stunting in Malawi: A Cluster-Randomized Trial. J Nutr 2018; 148:1587-1597. [PMID: 30204916 PMCID: PMC6168702 DOI: 10.1093/jn/nxy148] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022] Open
Abstract
Background Children in Malawi face nutritional risks related to low-quality diets and chronic malnutrition. Objective This study evaluated the impact of a 1-y early childhood development (ECD) center-based agriculture and nutrition intervention aimed at improving household production diversity, maternal knowledge on child nutrition and feeding practices, and children's diets and anthropometric measures. Methods A longitudinal cluster-randomized controlled trial was implemented in 60 community-based childcare centers (CBCCs), covering 1248 preschool children (aged 36-72 mo) and 304 younger siblings (aged 6-24 mo). CBCCs were randomly assigned to 1) a control group providing the Save the Children's ECD program or 2) a treatment group providing a standard ECD program with additional activities to improve nutritious food production and behavior change communication to improve diets and care practices for young children. Primary outcomes were household production and production diversity, preschooler enrollment and attendance, and dietary intake measured by quantitative 24-h recall and minimum diet diversity for younger siblings. Secondary outcomes included anthropometric measures for preschoolers and younger siblings, child development scores for preschoolers, and women's asset ownership and time use (the latter 2 are not discussed in this article). We used difference-in-difference (DID) estimates to assess impacts. Results Compared with the control group, preschool children in the intervention group had greater increases in nutrient intakes and in dietary diversity. No impacts on anthropometric measures were seen in preschoolers. Younger siblings in the intervention group had greater increases in height-for-age z scores than did children in the control group (DID: 0.44; P < 0.05) and greater reductions in the prevalence of stunting (DID: -17 percentage points; P < 0.05). The plausibility of the impact on growth in younger siblings was supported by effects along program impact pathways, including production of nutritious foods, caregiver knowledge, and dietary diversity. Conclusion Implementing an integrated agriculture and nutrition intervention through an ECD platform benefited children's diets and reduced stunting among younger siblings of targeted preschoolers. This trial was registered on the ISRCTN registry as ISCRCTN96497560.
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Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute, Washington, DC,Address correspondence to AG (e-mail: )
| | | | | | | | | | | | | | - Harold Alderman
- International Food Policy Research Institute, Washington, DC
| | - Marie Ruel
- International Food Policy Research Institute, Washington, DC
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Nguyen PH, Friedman J, Kak M, Menon P, Alderman H. Maternal depressive symptoms are negatively associated with child growth and development: Evidence from rural India. MATERNAL AND CHILD NUTRITION 2018; 14:e12621. [PMID: 29770998 PMCID: PMC6175434 DOI: 10.1111/mcn.12621] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022]
Abstract
Maternal depression has been suggested as a risk factor for both poor child growth and development in many low‐ and middle‐income countries, but the validity of many studies is hindered by small sample sizes, varying cut‐offs used in depression diagnostics, and incomplete control of confounding factors. This study examines the association between maternal depressive symptoms (MDSs) and child physical growth and cognitive development in Madhya Pradesh, India, where poverty, malnutrition, and poor mental health coexist. Data were from a baseline household survey (n = 2,934) of a randomized controlled trial assessing an early childhood development programme. Multivariate linear and logistic regression analyses were conducted, adjusting for socio‐economic factors to avoid confounding the association of mental health and child outcomes. MDS (measured using the Center for Epidemiologic Studies Short Depression Scale) was categorized as low, medium, and high in 47%, 42%, and 10% of mothers, respectively. The prevalence of child developmental delay ranged from 16% to 27% for various development domains. Compared with children of mothers with low MDS, those of high MDS mothers had lower height‐for‐age, weight‐for‐age, and weight‐for‐height z‐scores (0.22, 0.21, and 0.15, respectively), a higher rate of stunting and underweight (~1.5 times), and higher rate of developmental delay (partial adjusted odds ratio ranged from 1.3–1.8 for different development domains and fully adjusted odds ratio = 1.4 for fine motor). Our results—that MDS is significantly associated with both child undernutrition and development delay—add to the call for practical interventions to address maternal depression to simultaneously address multiple outcomes for both women and children.
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Affiliation(s)
| | | | | | - Purnima Menon
- International Food Policy Research Institute, Washington, DC, USA
| | - Harold Alderman
- International Food Policy Research Institute, Washington, DC, USA
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Maingi M, Kimiywe J, Iron-Segev S. Effectiveness of Baby Friendly Community Initiative (BFCI) on complementary feeding in Koibatek, Kenya: a randomized control study. BMC Public Health 2018; 18:600. [PMID: 29739374 PMCID: PMC5941766 DOI: 10.1186/s12889-018-5519-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Appropriate infant and young child nutrition is critical for proper growth and development. In order to promote optimal nutrition at an early age, the World Health Organization (WHO) and UNICEF have developed the Baby Friendly Hospital Initiative (BFHI) to address poor breastfeeding practices in maternity wards. However, impact is limited in less developed countries like Kenya, where more than half of all births are home deliveries. Therefore, Kenya has explored the adoption of Baby Friendly Community Initiative (BFCI) in its rural settings. In contrast to the BFHI, the BFCI supports breastfeeding and optimal infant feeding in community. BFCI has been implemented in Koibatek, in rural Kenya. This study aimed at assessing the effectiveness of BFCI on complementary feeding practices of children aged 6–23 months, by comparing intervention and control groups. Methods This was a randomized control study design that included 270 mother-infant pairs enrolled in the Baby Friendly Community Initiative (BFCI) project in Koibatek. Evaluation was carried out using structured questionnaires. Results A statistically significantly higher proportion of children in the intervention group compared to the control group attained minimum dietary diversity (77% vs. 58%; p = 0.001), minimum meal frequency (96% vs. 89%; p = 0.046) and minimum acceptable diet (77% vs. 61%; p = 0.005). The odds of attaining minimum dietary diversity, minimum meal frequency and minimum acceptable diet were statistically significantly higher for the intervention group compared to control group (OR: 4.95; 95%CI 2.44–10.03, p = < 0.001; OR: 14.84; 95%CI 2.75–79.9, p = 0.002; OR: 4.61; 95%CI 2.17–9.78, p = < 0.001 respectively). Conclusion The BFCI intervention was successful in improving complementary feeding practices. Strengthening and prioritizing BFCI interventions could have a significant impact on child health outcomes in rural Kenya. Trial registration ISRCTN03467700. Registration 24 September 2014. Retrospectively registered.
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Affiliation(s)
- Mildred Maingi
- School of Nutritional Sciences, The Hebrew University of Jerusalem and The International School of Agricultural Sciences, P.O Box 12-761001, Rehovot, Israel.
| | - Judith Kimiywe
- Department of Food Nutrition and Dietetics, Kenyatta University, P.O Box 43844-00100, Nairobi, Kenya
| | - Sharon Iron-Segev
- School of Nutritional Sciences, The Hebrew University of Jerusalem and The International School of Agricultural Sciences, P.O Box 12-761001, Rehovot, Israel
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