Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster‐randomized trial

Abstract

Stunting is associated with impaired cognitive and motor function. The effect of an education intervention including nutrition, stimulation, sanitation, and hygiene on child growth and cognitive/language/motor development, delivered to impoverished mothers in Uganda, was assessed. In a community-based, open cluster-randomized trial, 511 mother/children dyads aged 6-8 months were enrolled to an intervention (n = 263) or control (n = 248) group. The primary outcome was change in length-for-age z-score at age 20-24 months. Secondary outcomes included anthropometry and scores on the 2 developmental scales: Bayley Scales of Infant and Toddler Development-III and the Ages and Stages Questionnaire. There was no evidence of a difference in mean length-for-age z-score at 20-24 months between the 2 study groups: 0.10, 95% CI [-0.17, 0.36], p = .49. The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development-III, the mean difference being 15.6, 95% CI [10.9, 20.2], p = .0001; 9.9, 95% CI [6.4, 13.2], p = .0001; and 14.6, 95% CI [10.9, 18.2], p = .0001, for cognitive, language, and motor composite scores, respectively. The mean difference in scores from the Ages and Stages Questionnaire were 7.0, 95% CI [2.9, 11.3], p = .001; 5.9, 95% CI [1.2, 10.3], p = .01; 4.2, 95% CI [1.7, 6.7], p = .001; 8.9, 95% CI [5.3, 12.3], p = .0001; and 4.4, 95% CI [0.0, 8.8], p = .05, for communication, gross motor, fine motor, problem solving, and personal-social development, respectively. The intervention education delivered to mothers promoted early development domains in cognitive, language, and motor development but not linear growth of small children in impoverished rural communities in Uganda. Our study showed that child development may be improved with a relatively low cost intervention strategy. This trial was registered at ClinicalTrials.gov as NCT02098031.

Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis

“…51 studies provided nutritional supplementation 12-62 and 14 studies promoted responsive care and learning oppor tunities. 42,48,[63][64][65][66][67][68][69][70][71][72][73][74] These were the only two categories of intervention that were provided by five or more studies; therefore, analyses of pooled effect sizes focused on these two categories of intervention. Other interventions were water, sanitation, and hygiene (4 studies), 22,23,61,75 cash transfer (2 studies), 76,77 nutrition education (3 studies), 72,78,79 variation of the timing of maternal delivery by caesarean section (1 study), 80 foster care (1 study), 81 provision of antibiotics during pregnancy (1 study), 82 vaccination (1 study), 83 thyroxine supplementation in children with Down syndrome (1 study), 84 provision of nitric oxide to preterm infants (1 study), 85 and newborn erythropoietin treatment (1 study).…”

Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow‐up of a cluster‐randomised controlled trial

“…The significantly higher proportion of children with more erupted teeth in the intervention group at 20-24 months could be attributed to the intervention where mothers were encouraged to feed children on a more varied diet and 'silver fish' (mukene). Feeding children 'silver fish' was reportedly significantly more common in the intervention group than the control group (results in another paper [28]). This small fish, which is consumed whole, is rich in minerals [50] which could have facilitated the eruption of more teeth in the intervention group.…”

Aflatoxins: Occurrence, Exposure, and Binding to Lactobacillus Species from the Gut Microbiota of Rural Ugandan Children

“…These children took part in a randomized trial in the two districts of Kabale and Kisoro, located in the southwestern part of Uganda ( Figure 1). The trial assessed the effect of an educational intervention (focusing on nutrition, hygiene, and stimulation) on their growth and development as described in detail in previous publications [30,31]. Samples of the stool and urine were taken from every child in this study.…”

“…The concentration of aflatoxin B1 was determined in the food samples and aflatoxin M1 in the children's urine. Anthropometric measurements were taken as described by Muhoozi et al [30] and used to compute height-for-age Z-scores (HAZ) [32]. The frequently consumed regional foods (hulled and dehulled maize, and peanuts) at risk of aflatoxin contamination were identified based on a short food frequency questionnaire (Supplementary File S1).…”

“…However, L. plantarum was isolated in approximately 40% and L. brevis was isolated from only 20% of the subjects. All isolated Lactobacillus strains were assessed for their ability to bind aflatoxin B 1 [30]. All Lactobacillus isolates demonstrated binding of aflatoxin B 1 in physiological saline as shown in Table 2 at slightly variable levels.…”