Combined infant and young child feeding with small-quantity lipid-based nutrient supplementation is associated with a reduction in anemia but no changes in anthropometric status of young children from Katanga Province of the Democratic Republic of Congo: a quasi-experimental effectiveness study

Abstract

Background Small-quantity lipid-based nutrient supplements (SQ-LNS) are efficacious in controlled settings; data are scarce on the effectiveness utilizing health care delivery platforms. Objective We evaluated the impact of an infant young child feeding (IYCF)–SQ-LNS intervention on anemia and growth in children aged 6–18 mo in the Democratic Republic of Congo following a quasi-experimental effectiveness design. Methods An intervention health zone (HZ) received enhanced IYCF including improved counseling on IYCF during pregnancy until 12 mo after birth and daily use of SQ-LNS for infants 6–12 mo; the control HZ received the standard IYCF package. We analyzed data from 2995 children, collected in repeated cross-sectional surveys. We used adjusted difference-in-difference analyses to calculate changes in anemia, iron and vitamin A deficiencies, stunting, wasting, and underweight. Results Of mothers, 70.5% received SQ-LNS at least once in the intervention HZ, with 99.6% of their children consuming SQ-LNS at least once. The mean number of batches of SQ-LNS (28 sachets per batch, 6 batches total) received was 2.3 ± 0.8 (i.e., 64.4 ± 22.4 d of SQ-LNS). The enhanced program was associated with an 11.0% point (95% CI: −18.1, −3.8; P < 0.01) adjusted relative reduction in anemia prevalence and a mean +0.26-g/dL (95% CI: 0.04, 0.48; P = 0.02) increase in hemoglobin but no effect on anthropometry or iron or vitamin A deficiencies. At endline in the intervention HZ, children aged 8–13 mo who received ≥3 monthly SQ-LNS batch distributions had higher anthropometry z scores [length-for-age z score (LAZ): +0.40, P = 0.04; weight-for-age z score (WAZ): +0.37, P = 0.04] and hemoglobin (+0.65 g/dL, P = 0.007) and a lower adjusted prevalence difference of stunting (−16.7%, P = 0.03) compared with those who received none. Conclusions The enhanced IYCF–SQ-LNS intervention using the existing health care delivery platform was associated with a reduction in prevalence of anemia and improvement in mean hemoglobin. At endline among the subpopulation receiving ≥3 mo of SQ-LNS, their LAZ, WAZ, and hemoglobin improved. Future research could explore contextual tools to maximize coverage and intake adherence in programs using SQ-LNS.

Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials

“…Thus, further research is needed to investigate potential dose–response relations. In a recent evaluation of a program in the Democratic Republic of Congo in which SQ-LNS was distributed to infants 6–12 mo of age ( 55 ), dose-response was examined among children in the intervention zone who were 8–13 mo of age at endline, who were expected to have sufficient program exposure to expect a biological impact. Within that subsample, and adjusting for multiple potential confounding variables, children who had received ≥3 monthly distributions of SQ-LNS ( n = 80) had significantly greater LAZ (+0.4; 95% CI: 0.02, 0.78) and a lower prevalence of stunting (−16.7 percentage points; 95% CI: −32.1, −1.2 percentage points) than those who did not receive SQ-LNSs ( n = 89), whereas those who received 1–2 monthly distributions of SQ-LNSs ( n = 136) did not differ from those who did not receive SQ-LNSs (LAZ: +0.08; 95% CI: −0.24, 0.41; stunting PD: −9.3; 95% CI: −22.6, 3.9).…”

Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials

“…Thus, further research is needed to investigate potential dose-response relationships. In a recent evaluation of a program in the Democratic Republic of Congo in which SQ-LNS was distributed to infants 6-12 months of age (52), dose-response was examined among children in the intervention zone who were 8-13 months of age at endline, who were expected to have sufficient program exposure to expect a biological impact. Within that subsample, and adjusting for multiple potential confounding variables, children who had received at least 3 monthly distributions of SQ-LNS (n=80) had significantly greater LAZ (+0.4 (0.02, 0.78)) and a lower prevalence of stunting (−16.7 (−32.1, −1.2) percentage points) compared to those who did not receive SQ-LNS (n=89), whereas those who received 1-2 monthly distributions of SQ-LNS (n=136) did not differ from those who did not receive SQ-LNS (LAZ +0.08 (−0.24, 0.41); stunting prevalence difference −9.3 (−22.6, 3.9)).…”

Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review

“…Our review identified 15 newer isotopic studies (published alongside their trials registry entries and conference abstracts, since early 2013), which between them addressed absorption, metabolism, balance, body depots and excretion (see Table 2 [ 32 , 36 , 68 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 89 , 90 ], alongside nine older isotopic studies [ 88 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ]). The potentially most relevant recent trials explored the effects of multiple nutrient supplementation [ 99 , 100 , 101 , 102 , 103 ], vitamin A supplementation on iron metabolism [ 104 ] or supplementation in conjunction with other treatments [ 105 ]. Older trials assessed the effects of vegetables and green leaves [ 96 , 106 ], milk formula [ 107 ], fortified seasoning powder [ 108 ], micronutrient supplement [ 109 ] and high-dose supplementation [ 110 , 111 , 112 , …”