Effect of early-life nutrition and WASH interventions on the long-term health of Zimbabwean children
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: 1000 children who were born in 2013-2016 and participated in the Sanitation Hygiene Infant Nutrition Efficacy trial in rural Zimbabwe (NCT01824940) will be assessed at 7 years of age for: i) Neurodevelopment: cognition, memory, spatial ability, reasoning, reading, literacy, attention, and socio-emotional behavior; ii) Physical health: hand/trunk muscle strength, exercise capacity, blood pressure and hemoglobin; iii) Growth and metabolic health: anthropometry, and body composition. The effect of IYCF and WASH on each outcome will be assessed by intention-to-treat analysis, capitalizing on the factorial trial design.
IMPACT: This study will provide crucial evidence of whether early-life nutrition and WASH interventions have tangible benefits for long-term cognitive and functional performance without increasing metabolic risk. This has enormous potential impact for programs considering the global burden of stunting and the need for evidence-based interventions with long-term impact.