Child Diet and Household Characteristics Relate Differently to Child Development at the Beginning and the End of the Second "1000 Days" in Rural Nepal

A multi-sectoral community development intervention has a positive impact on diet quality and growth in school-age children in rural Nepal

Poor diet quality (diet diversity and animal-source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school-age children compared to children <5 years of age, especially in low/middle-income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school-age children is needed. A 36-month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school-age children (5-8 years at baseline) in these households; the present study analysed findings in the cohort of school-age children seen at all five study visits (n = 341). Diet quality improved more in the full package school-age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z-scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi-sectoral community development intervention was associated with improvements in diet and growth of school-age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school-age children can be favourably influenced by community-level interventions, even indirectly.

Diet and development among children aged 36-59 months in low-income countries

OBJECTIVE

To assess the associations between diet, stimulation and development among children 36-59 months of age in low-income and middle-income countries (LMICs).

DESIGN

We pooled Demographic and Health Survey data on 12 126 children aged 36-59 months from 15 LMICs. Child diet indicators included dietary diversity score (DDS, range 0-7), minimum dietary diversity (MDD, defined as DDS ≥4) and animal source foods (ASFs) consumption. Child development was assessed using the Early Childhood Development Index and stimulation by the number of stimulation activities (range 0-6). Associations were assessed using generalised linear models.

RESULTS

In our sample, 18% of children met MDD and 50% received ≥4 stimulation activities. The prevalence of suboptimal cognitive, socioemotional, literacy-numeracy and physical development was 24%, 32%, 87% and 11%, respectively. Higher DDS, meeting MDD and consuming ASFs were associated with 8%-13% more stimulation activities. Children who met MDD were slightly less likely to have suboptimal literacy-numeracy development compared with children who did not meet MDD: relative risk 0.97 (95% CI 0.95 to 1.00). DDS, meeting MDD and ASFs consumption were not associated with cognitive, socioemotional or physical development. However, there was evidence of positive associations between MDD and cognitive and literacy-numeracy development among subgroups of children, including those who received ≥4 stimulation activities or attended an early childhood care and education programme.

CONCLUSIONS

Child diet was associated with more stimulation activities. However, independent of stimulation, socioeconomic status and other factors, child diet appeared to be a prominent determinant only of literacy-numeracy development among children 36-59 months of age.