Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial

Luby, Stephen P.; Rahman, Mahbubur; Arnold, Benjamin F.; Unicomb, Leanne; Ashraf, Sania; Winch, Peter J.; Stewart, Christine P; Begum, Farzana; Hussain, Faruqe; Benjamin‐Chung, Jade; Leontsini, Elli; Naser, Abu Mohd; Parvez, Sarker Masud; Hubbard, Alan; Lin, Audrie; Nizame, Fosiul Alam; Jannat, Kaniz; Ercümen, Ayşe; Ram, Pavani K.; Das, Kishor Kumar; Abedin, Jaynal; Clasen, Thomas; Dewey, Kathryn G.; Fernald, Lia C. H.; Null, Clair; Ahmed, Tahmeed; Colford, John M.

doi:10.1016/s2214-109x(17)30490-4

Cited by 549 publications

(797 citation statements)

References 37 publications

Supporting

Mentioning

724

Contrasting

Unclassified

Order By: Relevance

“…The SHINE results are not yet fully published in peer-reviewed journals, but have been presented at meetings. The WASH Benefits results have been published recently [7,8]. The trial arms that included improved infant and young child feeding (IYCF) advice showed evidence of improvements in growth, but the effect sizes were very small.…”

Section: Nutrition-specific and Nutrition-sensitive Causes Of Undernumentioning

confidence: 99%

The Double Burden of Malnutrition in Countries Passing through the Economic Transition

Prentice¹

2018

Ann Nutr Metab

View full text Add to dashboard Cite

Undernutrition in both its acute and chronic forms (wasting and stunting) is strongly inversely correlated with the wealth of nations. Consequently, as many low- and middle-income countries (LMICs) achieve economic advancement and pass through the so-called “nutrition transition,” their rates of undernutrition decline. Many countries successfully achieved the Millennium Development Goal of halving undernutrition and whole continents have been transformed in recent decades. The exception is Africa where the slower rates of decline in the prevalence of undernutrition has been overtaken by population growth so that the absolute number of stunted children is rising. In many regions, economic transition is causing a rapid increase in the number of overweight and obese people. The rapidity of this rise is such that many nations bear the simultaneous burdens of under- and overnutrition; termed the “double burden” of malnutrition. This double burden, accompanied as it is by the unfinished agenda of high levels of infectious diseases, is crippling the health systems of many LMICs and thus requires urgent attention. Although the prognosis looks threatening for many poor countries, they have the advantage of being able to learn from the mistakes made by other nations that have passed through the transition before them. Concerted action across many arms of government would achieve huge future dividends in health and wealth for any nations that can grasp the challenge.

show abstract

Section: Nutrition-specific and Nutrition-sensitive Causes Of Undernumentioning

confidence: 99%

The Double Burden of Malnutrition in Countries Passing through the Economic Transition

Prentice¹

2018

Ann Nutr Metab

View full text Add to dashboard Cite

show abstract

“…A cluster‐randomized trial in rural India showed that responsive feeding education improved dietary intake and cognitive development of young children following 1 year of intervention; however, there was no impact on infant growth (Vazir et al, ). In our trial, we detected a significant improvement in child linear growth (Luby et al, ) in the two nutrition arms that received LNS together with counselling on improved infant and young child feeding practices.…”

Section: Discussionmentioning

confidence: 52%

“…The study had statistical power to detect small effects. Randomization successfully generated balanced background characteristics across arms (Luby et al, ). Loss to follow‐up was around 16% over 2 years and balanced across arms.…”

Section: Discussionmentioning

confidence: 99%

“…Loss to follow‐up was around 16% over 2 years and balanced across arms. The trial was implemented with high fidelity, as evidenced by the high uptake of the WSH technologies and behaviours and LNS adherence in both the single and combined intervention arms (Parvez et al, 2018; Luby et al, ). On the other hand, this study suffered from some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the nature of the intervention, neither the participants nor the data collectors were masked. The detail of the study design and rationale have been published (Arnold et al, ; Luby et al, ).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Complementary feeding practices among rural Bangladeshi mothers: Results from WASH Benefits study

Jannat

Luby

Unicomb

et al. 2018

Maternal & Child Nutrition

Self Cite

View full text Add to dashboard Cite

Inappropriate complementary feeding contributes to linear growth faltering in early childhood. Behaviour change interventions have been effective at improving practice, but few studies have investigated the effects of multicomponent integrated interventions. We conducted a cluster-randomized controlled trial in rural Bangladesh in which geographic clusters were randomized into seven arms: water treatment (W), sanitation (S), handwashing (H), water, sanitation, and handwashing (WSH), improved nutrition with infant and young child feeding messages and lipid-based nutrient supplementation for 6- to 24-month olds (N), N+WSH, and control. The objective of this paper was to examine the independent and combined effects of interventions on indicators of complementary feeding. Approximately 1 and 2 years after initiation of the intervention, research assistants surveyed mothers about infant feeding practices. Complementary feeding was examined using the World Health Organization indicators of infant and young child feeding practices. We used Poisson regression models to estimate prevalence ratios and linear regression models for prevalence differences with clustered sandwich estimators to adjust for clustering. A total of 4,718 households from 720 clusters were surveyed at year 1 and 4,667 at year 2. The children in the nutrition arms had a higher prevalence of meeting the minimum dietary diversity score compared with controls (year 1: N: 66.4%; N+WSH: 65.0% vs. C:32.4%; year 2: N: 91.5%; N+WSH: 91.6% vs. C:77.7%). Children in the nutrition arms received diverse food earlier than the children in control arm. In addition, the average consumption of lipid-based nutrient supplementation was >90% in each follow-up. Nutrition-specific interventions could be integrated with nutrition-sensitive interventions such as WSH without compromising the uptake of the nutrition intervention.

show abstract

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Park

Fang

Harari³

et al. 2019

JAMA Netw Open

View full text Add to dashboard Cite

IMPORTANCE The first 1000 days of life represent a critical window for child development. Pregnancy, exclusive breastfeeding (EBF) period (0-6 months), and complementary feeding (CF) period (6-24 months) have different growth requirements, so separate considerations for intervention strategies are needed. No synthesis to date has attempted to quantify the associations of interventions under multiple domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, water sanitation, and hygiene across these 3 life periods with birth and growth outcomes. OBJECTIVE To determine the magnitude of association of interventions with birth and growth outcomes based on randomized clinical trials (RCTs) conducted in low-income and middle-income countries (LMICs) using Bayesian network meta-analyses. DATA SOURCES MEDLINE, Embase, and Cochrane databases were searched from their inception up to August 14, 2018. STUDY SELECTION Included were LMIC-based RCTs of interventions provided to pregnant women, infants (0-6 months), and children (6-24 months). DATA EXTRACTION AND SYNTHESIS Two independent reviewers used a standardized data extraction and quality assessment form. Random-effects network meta-analyses were performed for each life period. Effect sizes are reported as odds ratios (ORs) and mean differences (MeanDiffs) for dichotomous and continuous outcomes, with 95% credible intervals (CrIs). This study calculated probabilities of interventions being superior to standard of care by at least a minimal clinically important difference. MAIN OUTCOMES AND MEASURES The study compared ORs on preterm birth and MeanDiffs on birth weight for pregnancy, length for age (LAZ) for EBF, and height for age (HAZ) for CF. RESULTS Among 302 061 participants in 169 randomized clinical trials, the network meta-analyses found several nutritional interventions that demonstrated greater association with improved birth and growth outcomes compared with standard of care. For instance, compared with standard of care, maternal supplements of multiple micronutrients showed reduced odds for preterm birth (OR, 0.54; 95% CrI, 0.27-0.97) and improved mean birth weight (MeanDiff, 0.08 kg; 95% CrI, 0.00-0.17 kg) but not LAZ during EBF (MeanDiff, −0.02; 95% CrI, −0.18 to 0.14). Supplementing infants and children with multiple micronutrients showed improved LAZ (MeanDiff, 0.20; 95% CrI, 0.03-0.35) and HAZ (MeanDiff, 0.14; 95% CrI, 0.02-0.25). The study found that pregnancy interventions (continued) Key Points Question Which interventions under the domains of nutrition, deworming, maternal education, and water, sanitation, and hygiene can improve birth and linear growth outcomes during the first 1000 days of life in low-income and middle-income countries (LMICs)? Findings This study used Bayesian network meta-analyses of 169 randomized clinical trials including 302 061 participants and showed that several nutritional interventions demonstrating greater associations with improved outcomes compared with standard of care, whi...

show abstract

Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial

Cited by 549 publications

References 37 publications

The Double Burden of Malnutrition in Countries Passing through the Economic Transition

The Double Burden of Malnutrition in Countries Passing through the Economic Transition

Complementary feeding practices among rural Bangladeshi mothers: Results from WASH Benefits study

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Contact Info

Product

Resources

About