Research Article: Home- and community-based growth monitoring to reduce early life growth faltering: an open-label, cluster-randomized controlled trial

Date Published: October 23, 2017

Publisher: American Society for Nutrition

Author(s): Günther Fink, Rachel Levenson, Sarah Tembo, Peter C Rockers.

http://doi.org/10.3945/ajcn.117.157545

Abstract

Background: Despite the continued high prevalence of faltering growth, height monitoring remains limited in many low- and middle-income countries.

Partial Text

Research estimates that globally, 167 million children (25.6%) aged <5 y have stunted growth, with prevalence rates >40% in several sub-Saharan African and South Asian countries (1, 2). While linear growth and stunted growth are widely used at the regional or national level as indicators for the nutritional status of children aged <5 y, height information is rarely provided to parents and caregivers in many low-income countries where routine health checkups for children <5 y old primarily focus on weight assessments to track children’s physical growth (3). Figure 1 summarizes the overall study design and participant retention. A total of 547 of 569 targeted children (96.1%) and their caregivers were enrolled in the study across 127 villages in September and October 2014. We reassessed 512 children (93.6%) at the study’s end in September 2015. Of the 512 end-of-study surveys, 15 did not have valid anthropometric assessments: in 8 cases (1.5%) the caregiver refused measurement, and in 7 cases (1.4%) data were not recorded correctly on the mobile devices. No statistically significant differences were found in follow-up rates across groups (P = 0.70). The results of the randomized controlled trial presented here suggest that interventions aiming to increase parents’ awareness of their children’s current height status have only limited impact on children’s physical growth and development overall. While neither intervention significantly affected the main outcomes of the trial, we observed positive changes for both weight and height in the HBGM group, although the height improvements were statistically significant only among children with stunted growth at baseline. Surprisingly, similar effects were not found for community-based growth monitoring, despite the fact that children with HAZ <−2 were provided with additional food supplements as part of these meetings. This finding does not seem to be driven by lack of parental interest in monitoring, as more than three-quarters of parents in the study, on average, attended the community meetings (Supplemental Table 3). Results from our interaction analysis suggest that the CBGM+NS intervention actually decreased mean HAZ and WAZ among children without stunted growth, whereas more positive effects were found for children targeted by nutritional supplements. While the relatively small sample size of the study limits our ability to identify directly the mechanisms underlying these results, it is possible that parents taking their children to community meetings incorrectly interpreted positive feedback received from official measurements (evidence of their children not having stunted growth) as a signal to not worry about their children’s nutritional status, and thus reduced their effort to support children. It is also possible that parents attending community measurement meetings were disappointed by the fact that their child was not eligible for the food supplements provided to children with stunted growth and thus became less concerned about their children’s nutritional status. Last, as with all trials, we cannot rule out the possibility that this finding is the result of measurement or sampling error.   Source: http://doi.org/10.3945/ajcn.117.157545

 

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