Project Details

E.W. "Al" Thrasher

Status: Funded - Open

The effect of water, sanitation, hygiene, and nutrition interventions during the first two years of life on anemia and micronutrient status

Christine Stewart, Ph.D., MPH


BACKGROUND: Anemia in preschool children results in poor physical growth, impaired cognitive development, reduced school achievement and, when severe, may result in increased mortality risk. 

GAP: Anemia is a multi-factoral disorder caused by nutritional deficiencies, infection, or genetic predisposition, although most public health prevention programs in developing countries have focused on iron supplementation.  No interventions designed to both improve nutrition and reduce infection simultaneously have rigorously evaluated the impact on anemia.

HYPOTHESIS: The primary objective of this project is to evaluate the efficacy of low-cost water, sanitation, hygiene, and nutrition interventions alone and in combination for reducing anemia and improving micronutrient status in young children.  We have three hypotheses: 1) improved water, sanitation, hygiene or nutrition will reduce the risk of anemia and will improve micronutrient status; 2) biomarkers of gut inflammation and malabsorption measured at <6 mo, 6-15 mo, or 18-27 mo will be associated with a higher prevalence of anemia and poorer micronutrient status at 18-27 mo; and 3) anemia will be associated with poor micronutrient status (folate, vitamin B12, iron and vitamin A), infection (including malaria, enteric parasites, and diarrheal disease), and inherited hemoglobin disorders (thalassemia and sickle cell).

METHODS: This study is a community-based randomized controlled trial in rural Kenya and Bangladesh with the following four groups: 1) lipid-based nutrient supplements (N); 2) chlorine treated water, improved pit latrines and child potties, and handwashing with soap (WSH); 3) WSH+N combined; and 4) control group.  Each intervention includes a targeted behavior change communication component.  Pregnant women will be enrolled and their children (N=1500 per country) will be followed for two years.  We will measure hemoglobin, markers of iron, vitamin A, folate and B12 status, and markers of inflammation (c-reactive protein, α-1-acid glycoprotein).  We will also identify genotype of inherited hemoglobin disorders (thalassemia and sickle cell). 

RESULTS: Pending

IMPACT: This project will better describe the epidemiology and etiology of anemia in two rural developing country populations and provide rigorous evidence of the efficacy of low-cost scalable public health interventions for reducing anemia in children.

Anemia, Infectious Disease, Micronutrients, Biomarkers, Non-Randomized Clinical Trial, Prevention, Human

Supervising Institution:
University of California, Davis

Project Location:
United States, Kenya, Bangladesh

Award Amount: