Effects of a home-based participatory play intervention on infant and young child nutrition: a randomised evaluation among low-income households in El Alto, Bolivia

A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children ( n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the complementary feeding group (CF group) received recommendations on complementary foods and the responsive complementary feeding and play group (RCF&P group) received recommendations on complementary foods plus skills on responsive feeding and play. The intervention was delivered in biweekly home visits to caregivers using flip charts. At postintervention, infants ( n = 521) were assessed for development (Bayley‐II scales) and their home environment was assessed (Home Observation for Measurement of the Environment [HOME] scale). Cluster adjusted analysis of variance showed no significant differences at baseline. The HOME score at 15 months differed by group, F (2, 38) = 6.41, P = 0.004; the CF and RCF&P groups had higher scores than the C group. Scores on subscales ‘Opportunities for Variety in Daily Stimulation’ and ‘Caregiver Promotion of Child Development’ (CPCD) were higher for the RCF&P group than for the C and CF groups. Mental development index (MDI) scores differed by group, F (2, 37) = 3.31, P = 0.04, with the RCF&P group showing higher scores than the C group ( P < 0.04); no differences were noted in psychomotor development index (PDI) scores ( P = 0.48). The subscales of HOME associated with MDI at 15 months were ‘CPCD’ and ‘Cleanliness of Child’ ( R 2 = 0.076). ‘CPCD’ was also associated with PDI ( R 2 = 0.039). A responsive complementary feeding and play intervention delivered through home visits benefitted children's mental development and caregiving environment at 15 months.

Section: Discussionmentioning

confidence: 70%

A complementary feeding and play intervention improves the home environment and mental development among toddlers in rural India

Rao

Bentley

Balakrishna

et al. 2020

“…The six eligible studies included four randomised controlled trials (Iannotti et al, 2014; Martinez et al, 2018; Smuts et al, 2019; Strand et al, 2015) and two cluster‐randomised controlled trials (More et al, 2017; Tomlinson, Rotheram‐Borus, Scheffler, & le Roux, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies involved home-based visits: one included promotion of optimal IYCF practices by trained 'Mentor Mother' community health workers (Tomlinson et al, 2018) and one incorporated play-based nutritional education messages (Martinez et al, 2018). Only one study took an integrated community-based approach with the introduction of local resource centres in addition to home visits and day-care centre interventions (More et al, 2017).…”

Section: Description Of Studiesmentioning

confidence: 99%

Improving nutritional status among urban poor children in sub‐Saharan Africa: An evidence‐informed Delphi‐based consultation

Mutisya

Markey

Rousham

et al. 2020

In sub-Saharan Africa (SSA), rapid urbanisation coupled with the high prevalence of infant and young child (IYC) undernutrition in low-income settings means that interventions to support IYC nutrition are a priority. Little is known about how urbanisation influences IYC feeding (IYCF) practices, and evidence-based interventions to improve IYC health/nutrition in the urban poor are lacking. Therefore, this research aimed to (a) systematically review evidence on interventions for improving the nutritional status of IYC aged 6-23 months living in urban poor areas (PROSPERO CRD42018091265) and (b) engage stakeholders to identify the highest ranking evidence gaps for improving IYCF programmes/policies. First, a rapid systematic review was conducted. This focused on the literature published regarding nutrition-specific and nutrition-sensitive complementary feeding interventions in urban poor areas, specifically low-income informal settlements, in low-and middle-income countries (LMICs). Six intervention studies met the review inclusion criteria. Intervention adherence was generally high, and indicators of maternal knowledge and IYC nutritional intake typically increased because of the interventions, but the impact on anthropometric status was small. Second, stakeholders working across SSA were engaged via a Delphi-based approach to identify priority areas for future intervention. Stakeholders reported that a situational analysis was required to better understand IYCF in urban poor areas, particularly the causes of IYC undernutrition, and highlighted the need to involve local communities in defining how future work should proceed. Together, these findings indicate a need for more evidence regarding IYCF and the factors that drive it in urban poor areas across LMIC settings, but particularly in SSA.

“…We analysed panel data from a community nutrition programme in Bolivia that collected rich child nutrition, food consumption and household demographic and socio‐economic survey data (Martinez et al, 2018). The survey was implemented in the eighth district of El Alto, a low‐income, predominately indigenous population where all households have access to electricity, but there is substantial variation in refrigerator ownership.…”

Section: Methodsmentioning

confidence: 99%

“…Child nutrition was assessed using the following anthropometrics measures: (1) height‐for‐age z score, (2) weight‐for‐age z score, (3) weight‐for‐height z score and (4) BMI‐for‐age z score. Height and weight were measured using standardized methods (Martinez et al, 2018). Height was measured using a wood infantometer, and weight was measured using a SECA scale with a precision of ±50 g; z scores were calculated from raw height and weight measures using the WHO Anthro Software in Stata.…”

Section: Methodsmentioning

confidence: 99%

Refrigeration and child growth: What is the connection?

Martínez

Murguia

Rejas

et al. 2021

Self Cite

Child stunting in Latin America and the Caribbean (LAC) decreased from 22.9% in 1990 to 9.6% in 2017. While stunting rates in the region were falling, access to electricity and refrigeration were on the rise. Despite a large body of evidence surrounding the effects of refrigeration on food consumption, and separately of the importance of food consumption for child health and nutrition, surprisingly few studies explore the potential effects of refrigeration on child nutrition. We studied the relationship between refrigeration and child nutrition outcomes using rich panel data for 1298 low-income households with children younger than 12 months at baseline in El Alto, Bolivia. We estimated the effects of refrigerator ownership on diet and nutrition outcomes using a difference-indifference approach. Owning a refrigerator was associated with increased food expenditures and improved child nutrition. We found evidence that households that acquired a refrigerator were more likely to buy food that requires refrigeration, and children in households that acquired refrigerators were 0.17 standard deviations taller for their age after 2 years. We also found that refrigeration was associated with a 0.26 standard deviation decline in BMI-forage , an effect driven by increased height rather than lower weight. These results suggest that refrigeration may play a role in explaining reductions in undernutrition observed in low-and middle-income countries in recent decades.