Effectiveness of Nutrition and WASH/malaria educational community-based interventions in reducing anemia in children from Angola

Abstract

We found no published data in Angola regarding the effect of combining nutrition-specific and nutrition-sensitive approaches in the reduction of anemia in preschool children. Thus, we implemented a cluster-randomized controlled trial to determine the effectiveness of two educational-plus-therapeutic interventions, in Nutrition and WASH/Malaria, in reducing anemia. We compared them to (1) a test-and-treat intervention and (2) with each other. A block randomization was performed to allocate 6 isolated hamlets to 3 study arms. A difference-in-difference technique, using Fit Generalized estimating models, was used to determine differences between the children successfully followed in all groups, between 2015 and 2016. We found no significant differences in anemia´s and hemoglobin variability between educational and the control group. However, the WASH/Malaria group had 22.8% higher prevalence of anemia when compared with the Nutrition group, having also higher prevalence of P. falciparum. Thus, our results suggest that adding a 12-month educational Nutrition or a WASH/Malaria component to a test-and-treat approach may have a limited effect in controlling anemia. Possibly, the intensity and duration of the educational interventions were not sufficient to observe the amount of behavior change needed to stop transmission and improve the general child feeding practices.

Child-Owned Poultry Intervention Effects on Hemoglobin, Anemia, Concurrent Anemia and Stunting, and Morbidity Status of Young Children in Southern Ethiopia: A Cluster Randomized Controlled Community Trial

“…Home fortification of children’s diet using micronutrient sprinkles [ 13 , 14 , 15 ] and lipid-based nutrient supplements [ 16 , 17 , 18 , 19 ] are well-documented strategies of anemia reduction, improvement of iron status, and hemoglobin levels. Nutrition education that improved infant feeding practices significantly decreased anemia and increased hemoglobin compared with the existing intervention [ 20 ] and WASH/Malaria intervention [ 21 ].…”

Household environment associated with anaemia among children aged 6–59 months in Ethiopia: a multilevel analysis of Ethiopia demographic and health survey (2005–2016)

“…This indicates that much more effort and resources are needed to address anaemia as a global scourge and to improve the health outcomes of affected children and individuals. As in many SSA nations including Ethiopia, the high incidence of anaemia may also be related to other factors such as poor child feeding practices, poor dietary diversity, iron deficiencies, and high rates of geohelminth infection in children [ 3 , 4 , 7 , 10 , 37 , 58 ]. In Ethiopia, mothers frequently give children cattle, camel, and goat milk, all of which are known to limit the absorption of iron [ 59 ].…”

“…The control variables used in this study were generated based on literature [ 34 , 37 ] and their availability in the EDHS dataset. The identified factors were categorised into child, maternal, household, and community-level factors.…”

Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study

“…A control variable, also known as a covariate, is a variable that is included in an analysis to account for potential confounding factors or to control for their influence on the relationship between the independent and dependent variables. The control variables used in this study were generated based on literature [ 8 , 51 , 53 , 56 , 69 , 78 , 79 ] and their availability in the EDHS dataset. The sex of the child (male, female), age of the child (6–11 months, 12–23, 24–35, and 36–59 months), perceived size of the child at birth (large, average and small), received deworming medication in the last 6 month (yes, no), received iron supplementation in the last 6 months (yes, no), mother's age (< 18, 18–24, 25–34, or > = 35), mother's education (no education, primary and above), mother's current work status (yes, no), household wealth index (poor, middle, and rich), place of residence (rural, urban), and region.…”