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A comprehensive intervention package improves the linear growth of children under 2-years-old in rural Bangladesh: a
Gulshan Ara1, Kazi Istiaque Sanin2, Mansura Khanam2
1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. gulshan.ara@icddrb.org.
Insights
A nutrition intervention significantly improved child growth in Bangladesh. Egg and milk-based snacks, micronutrient powders, and counseling reduced stunting by 73% in ultra-poor households.
Area of Science:
- Public Health and Nutrition
- Global Health
- Child Development
Background:
- Childhood stunting and micronutrient deficiencies are major public health issues in developing countries, affecting one-third of children under five.
- Ultra-poor households in rural Bangladesh face significant challenges in providing adequate nutrition for infants and young children.
- Existing government health communication may not sufficiently address the complex nutritional needs of vulnerable populations.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive intervention package aimed at improving linear growth and dietary diversity in 6- to 12-month-old children.
- To assess the impact of egg/milk-based snacks, multiple micronutrient powders (MNP), and behavioral counseling on child growth outcomes.
- To determine the feasibility and impact of such interventions in resource-limited, ultra-poor settings.
Main Methods:
- A 1-year community-based cluster randomized controlled longitudinal experiment involving 412 mother-infant pairs in rural Bangladesh.
- Intervention group received monthly food vouchers for egg/milk-based snacks, MNP, and counseling on child feeding and handwashing.
- Control group received standard government health communication; analysis used mixed-effect linear regression models.
Main Results:
- The intervention group showed a significant increase in Length-for-Age Z-score (LAZ) by 0.37 (p < 0.001).
- The risk of stunting was reduced by 73% in the intervention group compared to the control group (OR: 0.27, p = 0.001).
- No significant differences in mean weight or length were observed between groups at baseline.
Conclusions:
- A comprehensive intervention package including nutrient-rich snacks and counseling effectively improved child growth and dietary diversity in ultra-poor Bangladeshi households.
- The findings support the potential for scaling up similar resource-limited interventions to combat childhood stunting and malnutrition.
- Targeted nutritional support and education are crucial for improving child development outcomes in vulnerable populations.
Abstract:
Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-based cluster randomized controlled longitudinal experiment, 412 mother-infant pairs were randomly assigned to receive either monthly food vouchers (for eggs, milk, semolina, sugar, and oil) to prepare egg and milk-based snacks for their children, along with multiple micronutrient powder (MNP), counseling on child feeding and handwashing, or regular government health communication alone (control; n = 206, treatment; n = 206). The trial was conducted in 12 clusters (small administrative units of sub-district). The primary inclusion criteria were ultra-poor households with limited resources and having children under 2-years-old. The primary and secondary outcomes were differences in children's length gain and dietary diversity. The effect of intervention on child growth was examined using a mixed effect linear regression model. Mean weight and length of the children did not significantly differ between groups at baseline. Around 90% of the children in both groups were breastfed. After receiving intervention for 12 months, LAZ score increased by 0.37 (CI 0.24, 0.51, p < 0.001) and risk of stunting reduced by 73% (OR: 0.27, CI 0.13, 0.58, p = 0.001). This comprehensive intervention package improved the growth and dietary diversity of children in extremely poor Bangladeshi households. A scaling-up of this intervention in contexts with limited resources should be taken into consideration.Trial registration: This trial registered retrospectively at ClinicalTrials.gov as NCT03641001, 21/8/2018.
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