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Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh.
- Source :
- American Journal of Clinical Nutrition; Jan2019, Vol. 109 Issue 1, p148-164, 17p
- Publication Year :
- 2019
-
Abstract
- Background: Anemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene. Objective: We evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh. Design: We nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6–24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs. Results: In Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102). Conclusions: IYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention [ABSTRACT FROM AUTHOR]
- Subjects :
- ANEMIA
ARTIFICIAL feeding
BIOMARKERS
CLUSTER analysis (Statistics)
CONFIDENCE intervals
COUNSELING
DIETARY supplements
FOLIC acid deficiency
HAND washing
HEMOGLOBINS
HYGIENE
IRON deficiency anemia
LIPIDS
PREGNANT women
REGRESSION analysis
RURAL conditions
SANITATION
MICRONUTRIENTS
VITAMIN A deficiency
VITAMIN B12 deficiency
RANDOMIZED controlled trials
DISEASE prevalence
NUTRITIONAL status
DISEASE risk factors
Subjects
Details
- Language :
- English
- ISSN :
- 00029165
- Volume :
- 109
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- American Journal of Clinical Nutrition
- Publication Type :
- Academic Journal
- Accession number :
- 134829400
- Full Text :
- https://doi.org/10.1093/ajcn/nqy239