Project Details

Effect of early-life nutrition and WASH interventions on the long-term health of Zimbabwean children

Andrew Prendergast, MBBS, MRCPCH, DTM&H, DPhil

Summary

BACKGROUND: Stunting affects 22% of children globally, and is associated with poorer performance in school, and lower adult earnings. There is an urgent need to evaluate whether early-life interventions for stunting improve school-age child function. GAP: Does improved infant and young child feeding (IYCF) and/or improved water, sanitation and hygiene (WASH) implemented during the first 1000 days result in improved cognition, physical and metabolic health at school age? HYPOTHESIS: At 7 years of age: i) Children randomized to early-life IYCF will have improved cognition and physical function, with no increase in adiposity, compared to children not receiving IYCF; and ii) Children randomized to WASH will have similar cognition and physical function, compared to children not receiving WASH. METHODS: Children previously enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, who were 7-8 years old, HIV-unexposed, and still living in Shurugwi district were enrolled in a long-term follow-up study. Cognitive function using the Kaufman Assessment Battery for Children (KABC-II) was the primary outcome, with additional tools measuring executive function, literacy, numeracy, fine motor skills and socioemotional function. Physical function was assessed by handgrip strength, broad jump and the shuttle-run test. Growth was assessed by anthropometry, bioimpedance analysis and skinfold thicknesses. Intention-to-treat analyses used generalized estimating equations with an exchangeable working correlation structure to account for clustering. RESULTS: 1002 children (510 female) were assessed at mean (SD) age 7.3 (0.2) years. There was no effect of IYCF or WASH on the primary outcome (KABC-II score) or secondary cognitive outcomes, except a small improvement in socioemotional function in the WASH arms (-0.98 marks, 95% CI -1.73, -0.22, p=0.01). Children in IYCF arms had a greater handgrip strength (0.28 Kg, 95%CI 0.02, 0.53, p=0.03); in stratified analyses, effects were seen only in boys. There were no significant effects of either intervention on growth or body composition measures. IMPACT: Despite improved early-life growth following IYCF, we found minimal functional benefits by school-age. Interventions that are more comprehensive, delivered for longer, and include nurturing care to achieve a greater magnitude of effect should be considered to improve long-term human capital.