About 36% of children under five in Bangladesh suffer from stunting, with socio-economic and geographic factors affecting the prevalence of the condition.
While previous research had assessed the effects of 10 individual nutritional interventions during the first 1,000 days of life — defined as beginning from conception — in countries with the highest prevalence of childhood stunting, the combined effects of those interventions have not been fully explored.
Combination comparisons
As such, the ICDDR,B aims to address this gap by studying the combinations of five preventive interventions and their effects on length-for-age Z-scores (LAZ) among two-year-old children.
The RCT will use a total of 1,500 pregnant women from 125 rural clusters, with 25 clusters randomly assigned to either the comparison arm or one of the four intervention combinations. A minimum of 1,050 resultant children are expected to be retained for the study.
The first is behaviour change communication (BCC) regarding prenatal maternal nutrition, exclusive breastfeeding and complementary feeding, alongside prenatal nutrition supplementation (PNS) and complementary food supplementation (CFS).
The second involves BCC combined with PNS; the third, BCC with CFS; and the last, BCC alone. The comparison arm is provided with only health and nutrition services.
All the expectant mothers and their offspring will have their anthropometric measurements, nutritional intake and other relevant data collected during enrolment, twice during pregnancy, every month postpartum until the children are six months old, and every three months afterwards until they are two years old.
Pros and cons
The researchers said the study’s “major strengths” are its depth (multiple community-friendly evidence-based interventions) and breadth (interventions directed at both mother and child during the first 1,000 days of the child’s life).
It added that the study would assess the impact of the different intervention bundles on prenatal nutritional intake, gestational weight gain, birth weight, and infant- and young child-feeding practices.
The researchers said “the cluster RCT design in a community setting will offer robust evidence on the effectiveness of the bundles compared to the comparison arm, where routine practices will run unabated”.
“The relatively homogenous study population in a food-insecure area would further strengthen our inferences, as we would expect minimal inter-cluster differences that would otherwise potentially confound associations.”
However, they also admitted that they would be unable to collect biological samples from the subjects because of budget contraints, therefore preventing them from exploring potential biological mediators of the effects of nutrients, and “inherited differences in metabolism predisposing to the risk of stunting”.
However, they “anticipate that the results from this RCT will have policy-level implications in prioritising a set of interventions when addressing stunting — whether it is behaviour change communication only or combined with prenatal and / or post-natal nutritional supplementation”.
Source: BioMed Central
https://doi.org/10.1186/s12889-017-4281-0
“A community-based cluster randomised controlled trial to evaluate the effectiveness of different bundles of nutrition-specific interventions in improving mean length-for-age z score among children at 24 months of age in rural Bangladesh: study protocol”
Authors: Sk Masum Billah, et al.