Effectiveness of a home fortification programme with multiple micronutrients on infant and young child development: a cluster-randomised trial in rural Bihar, India

• Type of Material: Article
• Authors: Leila M. Larson, Emory University; Melissa Fox Young, Emory University; Patricia Bauer, Emory University; Rukshan Mehta, Emory University; Amy Webb Girard, Emory University; Usha Ramakrishnan, Emory University; Pankaj Verma, CARE India; Indrajit Chaudhuri, CARE India; Sridhar Srikantiah, CARE India; Reynaldo Martorell, Emory University
• Language: English
• Date: 2018-07-28
• Publisher: Cambridge University Press (CUP): PDF allowed
• Publication Version: Final Published Version
• Copyright Statement: © The Authors 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1017/S000711451800140X
• Title of Journal or Parent Work: British Journal of Nutrition
• ISSN: 0007-1145
• Volume: 120
• Issue: 2
• Start Page: 176
• End Page: 187
• Grant/Funding Information: Funding support was provided by a Bill and Melinda Gates Foundation grant through a subcontract with CARE India, and the Thrasher Research Fund.; Study funders did not have a role in the study design, data collection or manuscript preparation.
• Keywords: Nutrition & Dietetics; PRESCHOOL-CHILDREN; Life Sciences & Biomedicine; MEMORY; EXECUTIVE FUNCTION; Multiple micronutrient powder; Motor development; Mental development; RESPONSIVE STIMULATION; FACTORIAL EFFECTIVENESS TRIAL; Micronutrients; FULL-TERM; COGNITION; Child development; NUTRITION INTERVENTIONS; MIDDLE-INCOME COUNTRIES; SUPPLEMENTATION; Science & Technology
• Research Categories: Health Sciences, Nutrition; Health Sciences, Public Health

Abstract

Research demonstrates the importance of nutrition for early brain development. Few studies have examined the effectiveness of multiple micronutrient powders (MNP) on child development. This study examined the impacts of home fortification with MNP on motor and mental development, executive function and memory of children living in Bihar. This two-arm cluster-randomised effectiveness trial selected seventy health sub-centres to receive either MNP and nutrition counselling (intervention) or nutrition counselling alone (control) for 12 months. Front-line health workers delivered the intervention to all households in study communities with a child aged 6-18 months. Data were collected using cross-sectional surveys at baseline and endline by selecting households from intervention (baseline, n 2184; endline, n 2170) and control (baseline, n 2176; endline, n 2122) communities using a two-stage cluster-randomised sampling strategy. Children in the intervention group had a significantly larger improvement from baseline to endline compared with those in the control group on scores for motor and mental development (Cohen's d, motor=0·12; 95 % CI 0·03, 0·22; mental=0·15; 95 % CI 0·06, 0·25). Greater impacts of MNP on motor and mental development were observed in children from households with higher stimulation scores at baseline compared with those with lower stimulation (Cohen's d, motor=0·20 v. 0·09; mental=0·22 v. 0·14; P interaction<0·05). No significant treatment differences were seen for executive function or memory. Home fortification with MNP through the existing health infrastructure in Bihar was effective in improving motor and mental development and should be considered in combination with other child development interventions such as stimulation.