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Tubaramure, a Food-Assisted Integrated Health and Nutrition Program, Reduces Child Stunting in Burundi: A Cluster-Randomized Controlled Intervention Trial.
- Source :
-
Journal of Nutrition . Mar2018, Vol. 148 Issue 3, p445-452. 8p. - Publication Year :
- 2018
-
Abstract
- <bold>Background: </bold>Food-assisted maternal and child health and nutrition (FA-MCHN) programs are widely used to address undernutrition, but little is known about their effectiveness in improving child linear growth.<bold>Objective: </bold>We assessed the impact of Burundi's Tubaramure FA-MCHN program on linear growth. The program targeted women and their children during the first 1000 d and included 1) food rations, 2) strengthening of health services and promotion of their use, and 3) behavior change communication (BCC). A second objective was to assess the differential effect when varying the timing and duration of receiving food rations.<bold>Methods: </bold>We used a 4-arm, cluster-randomized controlled study to assess program impact with the use of cluster fixed-effects double-difference models with repeated cross-sectional data (baseline and follow-up 4 y later with ∼3550 children in each round). Treatment arms received food rations (corn-soy blend and micronutrient-fortified vegetable oil) for the first 1000 d (T24), from pregnancy through the child reaching 18 mo (T18), or from birth through the child reaching 24 mo ["no food during pregnancy" (TNFP)]. All treatment arms received BCC for the first 1000 d. The control arm received no food rations or BCC.<bold>Results: </bold>Stunting (height-for-age z score <2 SDs) increased markedly from baseline to follow-up, but Tubaramure had a significant (P < 0.05) beneficial effect in the T24 [7.4 percentage points (pp); P < 0.05], T18 (5.7 pp; P < 0.05), and TNFP (4.6; P = 0.09) arms; the differences in effect across arms were not significant (P > 0.01). Secondary analyses showed that the effect was limited to children whose mother and head of household had some primary education and who lived in households with above-median assets.<bold>Conclusions: </bold>FA-MCHN programs are an effective development tool to improve child linear growth and can protect children from political and economic shocks in vulnerable countries such as Burundi. A better understanding of how to improve the nutritional status of children in the worst-off households is needed. This trial was registered at www.clinicaltrials.gov as NCT01072279. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CHILD nutrition
*INTEGRATED health care delivery
*STUNTED growth
*MATERNAL health services
*MALNUTRITION
*RANDOMIZED controlled trials
*MICRONUTRIENTS
*ENRICHED foods
*COMPARATIVE studies
*DIET
*GROWTH disorders
*INFANTS
*RESEARCH methodology
*MEDICAL cooperation
*NUTRITIONAL requirements
*PREGNANT women
*RESEARCH
*STATISTICAL sampling
*STATURE
*SOCIOECONOMIC factors
*EVALUATION research
*AT-risk people
*CROSS-sectional method
*EVALUATION of human services programs
*NUTRITIONAL status
*DISEASE complications
*PREVENTION
*THERAPEUTICS
DEVELOPING countries
Subjects
Details
- Language :
- English
- ISSN :
- 00223166
- Volume :
- 148
- Issue :
- 3
- Database :
- Academic Search Index
- Journal :
- Journal of Nutrition
- Publication Type :
- Academic Journal
- Accession number :
- 128439266
- Full Text :
- https://doi.org/10.1093/jn/nxx063