Effectiveness of a home fortification programme with multiple micronutrients on infant and young child development: a cluster-randomised trial in rural Bihar, India

Larson, Leila M; Young, Melissa; Bauer, Patricia J.; Mehta, Rukshan; Girard, Amy Webb; Ramakrishnan, Usha; Verma, Pankaj; Chaudhuri, Indrajit; Srikantiah, Sridhar; Martorell, Reynaldo

doi:10.1017/s000711451800140x

Cited by 16 publications

(8 citation statements)

References 58 publications

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“…The elicited imitation task measures children's declarative memory ( 7 ). Our adaptation of the task comprised 8 items based on previously published versions of this task ( 18–21 ). Each item consisted of a set of toys and a sequence of 2 target actions.…”

Section: Methodsmentioning

confidence: 99%

Early Child Development Outcomes of a Randomized Trial Providing 1 Egg Per Day to Children Age 6 to 15 Months in Malawi

Prado

Maleta

Caswell

et al. 2020

The Journal of Nutrition

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ABSTRACT Background Eggs are a rich source of nutrients important for brain development, including choline, riboflavin, vitamins B-6 and B-12, folate, zinc, protein, and DHA. Objective Our objective was to evaluate the effect of the consumption of 1 egg per day over a 6-mo period on child development. Methods In the Mazira Project randomized controlled trial, 660 children aged 6–9 mo were randomly allocated into an intervention or control group. Eggs were provided to intervention households during twice-weekly home visits for 6 mo. Control households were visited at the same frequency. At enrollment, blinded assessors administered the Malawi Developmental Assessment Tool (MDAT), and 2 eye-tracking tasks using a Tobii-Pro X2–60 eye tracker: a visual paired comparison memory task and an Infant Orienting with Attention task. At endline, 6-mo later, blinded assessors administered the MDAT and eye-tracking tasks plus an additional elicited imitation memory task. Results At endline, intervention and control groups did not significantly differ in any developmental score, with the exception that a smaller percentage of children were delayed in fine motor development in the intervention group (10.6%) compared with the control group (16.5%; prevalence ratio: 0.59, 95% CI: 0.38–0.91). Among 10 prespecified effect modifiers for the 8 primary developmental outcomes, we found 7 significant interactions demonstrating a consistent pattern that children who were less vulnerable, for example, those with higher household wealth and maternal education, showed positive effects of the intervention. Given multiple hypothesis testing, some findings may have been due to chance. Conclusion The provision of 1 egg per day had no overall effect on child development in this population of children, however, some benefits may be seen among children in less vulnerable circumstances. This trial was registered at clinicaltrials.gov as NCT03385252.

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Section: Methodsmentioning

confidence: 99%

Early Child Development Outcomes of a Randomized Trial Providing 1 Egg Per Day to Children Age 6 to 15 Months in Malawi

Prado

Maleta

Caswell

et al. 2020

The Journal of Nutrition

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“…Both samples were randomly selected using a multistage cluster probability proportional to size design. Seventy health subcentres treated as clusters were selected randomly from a single district in Bihar, India, as part of a home fortification randomized effectiveness trial—clinical trial NCT02593136 (Larson et al, ; Young et al, ). A random subsample of 5,664 children were assessed for haemoglobin and anthropometry from a larger survey listing of children 6–18 months of age residing in randomly selected villages within the assigned health subcentre.…”

Section: Methodsmentioning

confidence: 99%

The co‐occurrence of anaemia and stunting in young children

Gosdin

Martorell

Bartolini

et al. 2018

Maternal & Child Nutrition

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Anaemia and stunting are prevalent nutritional problems among children of low-income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co-occur in affected individuals to a greater degree than by chance. In 2 populations of children-ages 6-18 months in Bihar, India, (n = 5,664) and 6-36 months in Lambayeque, Peru (n = 688)-we measured the frequency of the co-occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi-square test. We also built logistic regression models for each condition. The frequency of co-occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p = .97) and 31.5% (p = .85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition.

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“…Of the 56 intervention studies, 42 measured growth, 17 measured motor, and 22 measured mental, cognitive, language, or socioemotional development (Table S2, online only; in this table, see Refs. , , , , , and ). No iron supplementation trials meeting our inclusion criteria reported brain imaging or chronic disease outcomes.…”

Section: Resultsmentioning

confidence: 99%

Effects of increased hemoglobin on child growth, development, and disease: a systematic review and meta‐analysis

Larson

Kubes

Ramírez-Luzuriaga

et al. 2019

Annals of the New York Academy of Sciences

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In children under 5, a hemoglobin (Hb) cutoff of 11 g/dL is recommended by the World Health Organization to define anemia, yet few studies have examined whether this cut point accurately coincides with negative functional consequences. This systematic review and meta-analysis of iron intervention and observational studies aimed to clarify the consequences of low Hb concentration in children under age 5 years on growth, development, and chronic disease (functional outcomes) across the full range of Hb values. A literature search returned 5049 studies; of these, 56 intervention and 20 observational studies fit the inclusion criteria. Among iron supplementation trials, a metaregression indicated significant associations between intervention effects on Hb and their effects on motor and mental development. For each 1 standard deviation (SD) increase in Hb, motor scores increased by 0.28 SD and mental scores increased by 0.24 SD. Iron supplementation trials among children with lower Hb concentrations at baseline showed stronger associations between their effects on Hb and their effects on mental development (P-interaction = 0.008). Heterogeneity among observational studies precluded calculation of pooled associations between Hb and functional outcomes. Available evidence was not able to establish an inflection point at which decreasing Hb begins to be associated with negative functional outcomes. Future research is needed to examine associations of Hb with growth and development in populations with varying levels of Hb, inflammation, and in different ages and settings.

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Effectiveness of a home fortification programme with multiple micronutrients on infant and young child development: a cluster-randomised trial in rural Bihar, India

Cited by 16 publications

References 58 publications

Early Child Development Outcomes of a Randomized Trial Providing 1 Egg Per Day to Children Age 6 to 15 Months in Malawi

Early Child Development Outcomes of a Randomized Trial Providing 1 Egg Per Day to Children Age 6 to 15 Months in Malawi

The co‐occurrence of anaemia and stunting in young children

Effects of increased hemoglobin on child growth, development, and disease: a systematic review and meta‐analysis

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