Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial

  • The Lancet, Volume 371, No. 9612, Year 2008

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Study Justification:
– Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reducing childhood undernutrition.
– This study aimed to compare two World Vision programs for maternal and child health and nutrition to determine which model is more effective in reducing undernutrition in children.
Highlights:
– The study used a cluster randomized trial with 20 pairs of communities.
– The two programs tested were a preventive model, targeting all children aged 6-23 months, and a recuperative model, targeting underweight children aged 6-60 months.
– Both programs also targeted pregnant and lactating women.
– The study found that the preventive program was more effective in reducing childhood undernutrition compared to the recuperative model.
– Children in the preventive program had lower rates of stunting, underweight, and wasting, and higher anthropometric indicators compared to children in the recuperative program.
– The effect was greater in children exposed to the preventive program for the full span between 6 and 23 months of age.
Recommendations:
– Based on the findings, it is recommended to prioritize and invest in early nutrition interventions targeting children aged 6-23 months to prevent undernutrition.
– Policy makers should consider implementing preventive models of food assistance and behavior change and communication programs for maternal and child health and nutrition.
Key Role Players:
– World Vision or other relevant organizations involved in maternal and child health and nutrition programs.
– Local government agencies responsible for implementing nutrition interventions.
– Community leaders and volunteers who can support the implementation and monitoring of the programs.
– Health professionals and nutrition experts who can provide guidance and training.
Cost Items for Planning Recommendations:
– Training and capacity building for program implementers and health professionals.
– Development and dissemination of behavior change and communication materials.
– Monitoring and evaluation activities to assess program effectiveness.
– Provision of nutritious food and supplements for targeted children and pregnant/lactating women.
– Outreach and community engagement activities.
– Administrative and logistical support for program implementation.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it is based on a cluster randomized trial with a large sample size (roughly 1500 children per survey) and includes intention-to-treat analyses. The study is also registered with ClinicalTrials.gov. However, to improve the evidence, it would be helpful to provide more details on the specific methods used, such as the interventions implemented in each program and the specific outcomes measured. Additionally, including information on potential limitations of the study, such as attrition or confounding factors, would further strengthen the evidence.

Background: Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age. Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition. Methods: We used a cluster randomised trial to compare two World Vision programmes for maternal and child health and nutrition, which included a behaviour change and communication component: a preventive model, targeting all children aged 6-23 months; and a recuperative model, targeting underweight (weight-for-age Z score <-2) children aged 6-60 months. Both models also targeted pregnant and lactating women. Clusters of communities (n=20) were paired on access to services and other factors and were randomly assigned to each model. Using two cross-sectional surveys (at baseline and 3 years later), we tested differences in undernutrition in children aged 12-41 months (roughly 1500 children per survey). Analyses were by intention to treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. This study is registered with ClinicalTrials.gov, number NCT00210418. Findings: There were no differences between programme groups at baseline. At follow-up, stunting, underweight, and wasting (using WHO 2006 reference data) were 4-6 percentage points lower in preventive than in recuperative communities; and mean anthropometric indicators were higher by +0·14 Z scores (height for age; p=0·07), and +0·24 Z scores (weight for age and weight for height; p<0·0001). The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter durations during this period. The quality of implementation did not differ between the two programmes; nor did use of services for maternal and child health and nutrition. Interpretation: The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model. © 2008 Elsevier Ltd. All rights reserved.

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The innovation described in the study is the age-based preventive targeting of food assistance and behavior change and communication for the reduction of childhood undernutrition in Haiti. This approach involves targeting nutrition interventions earlier in life, specifically children aged 6-23 months, to prevent undernutrition before it occurs. The study compared this preventive model to a traditional recuperative model that targeted underweight children aged 6-60 months. The results showed that the preventive model was more effective in reducing childhood undernutrition, with lower rates of stunting, underweight, and wasting, and higher anthropometric indicators. The quality of implementation and use of services did not differ between the two models.
AI Innovations Description
The recommendation from the study is to implement an age-based preventive model for maternal and child health and nutrition programs. This model targets all children aged 6-23 months, as well as pregnant and lactating women. The study found that this preventive model was more effective in reducing childhood undernutrition compared to the traditional recuperative model, which targeted underweight children aged 6-60 months.

The preventive model resulted in lower rates of stunting, underweight, and wasting in children, as well as higher anthropometric indicators. The effect was greater in children who were exposed to the preventive program for the full span between 6 and 23 months of age.

This recommendation suggests that by targeting nutrition interventions earlier in life, before children become undernourished, it may be possible to improve access to maternal health and reduce childhood undernutrition more effectively.
AI Innovations Methodology
Based on the provided description, the study titled “Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial” focuses on comparing two World Vision programs for maternal and child health and nutrition in Haiti. The programs include a behavior change and communication component and aim to reduce childhood undernutrition.

The two models being compared are:
1. Preventive Model: This model targets all children aged 6-23 months, as well as pregnant and lactating women.
2. Recuperative Model: This model targets underweight children aged 6-60 months, as well as pregnant and lactating women.

The study used a cluster randomized trial design, where clusters of communities (n=20) were paired based on access to services and other factors, and then randomly assigned to either the preventive or recuperative model. Two cross-sectional surveys were conducted, one at baseline and another 3 years later, to assess the impact of the interventions on undernutrition in children aged 12-41 months.

The analysis was done using an intention-to-treat approach, comparing the differences in undernutrition between the two program groups. The analysis included both pairwise community-level comparisons and child-level analyses, adjusting for the clustering effect and child age and sex.

The findings of the study showed that the preventive program was more effective in reducing childhood undernutrition compared to the recuperative model. At follow-up, the prevalence of stunting, underweight, and wasting was lower in the preventive communities. Additionally, the mean anthropometric indicators (height for age, weight for age, and weight for height) were higher in the preventive communities.

The study also found that the duration of exposure to the preventive program during the 6-23 months age range had a greater effect on reducing undernutrition compared to shorter durations of exposure.

In summary, the study suggests that targeting nutrition interventions earlier in life, specifically during the 6-23 months age range, can be more effective in reducing childhood undernutrition compared to targeting underweight children aged 6-60 months. The methodology used in the study involved a cluster randomized trial design and the analysis was done using intention-to-treat approach, adjusting for clustering effect and child age and sex.

Statistics:
Citations: 108
Authors: 10
Identifiers:
DOI: 10.1016/S0140-6736(08)60271-8
ISSN: 01406736
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal and Child Health, Quality of Care
Study Design:
Cohort Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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