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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Study protocol

A community-based cluster randomised controlled trial to evaluate the effectiveness of different bundles of nutrition-specific interventions in improving mean length-for-age z score among children at 24 months of age in rural Bangladesh: study protocol

Authors: Sk Masum Billah, Tarana E. Ferdous, Mohd Anisul Karim, Michael J. Dibley, Shahreen Raihana, Md Moinuddin, Nuzhat Choudhury, Tahmeed Ahmed, D. M. Emdadul Hoque, Purnima Menon, Shams El Arifeen

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Prevalence of stunting among under-five children in Bangladesh is 36%, varying with geographic and socio-economic characteristics. Previously, research groups statistically modelled the effect of 10 individual nutrition-specific interventions targeting the critical first 1000 days of life from conception, on lives saved and costs incurred in countries with the highest burden of stunted children. However, primary research on the combined effects of these interventions is limited. Our study directly addresses this gap by examining the effect of combinations of 5 preventive interventions on length-for-age z-scores (LAZ) among 2-years old children.

Methods

This community-based cluster randomised trial (c-RCT) compares 4 intervention combinations against one comparison arm. Intervention combinations are: 1) Behaviour change communication (BCC) on maternal nutrition during pregnancy, exclusive breastfeeding, and complementary feeding, along with prenatal nutritional supplement (PNS) and complementary food supplement (CFS); 2) BCC with PNS; 3) BCC with CFS; and 4) BCC alone. The comparison arm receives only routine health and nutrition services. From a rural district, 125 clusters were selected and randomly assigned to any one of the five study arms by block randomisation. A bespoke automated tab-based system was developed linking data collection, intervention delivery and project supervision. Total sample size is 1500 pregnant women, with minimum 1050 resultant children expected to be retained, powered to detect a difference of at least 0.4 in the mean LAZ score of children at 24 months, the main outcome variable, between the comparison arm and each intervention arm. Length and other anthropometric measurements, nutritional intake and other relevant data on mother and children are being collected during enrolment, twice during pregnancy, postpartum monthly till 6 months, and every third month thereafter till 24 months.

Discussion

This c-RCT explores the effectiveness of bundles of preventive nutrition intervention approaches addressing the critical window of opportunity to mitigate childhood stunting. The results will provide robust evidence as to which bundle(s) can have significant effect on linear growth of children. Our study also will have policy-level implications for prioritising intervention(s) tackling stunting.

Trial registration

The study was retrospectively registered on May 2, 2016 and is available online at ClinicalTrials.gov (ID: NCT02768181).
Appendix
Available only for authorised users
Literature
1.
2.
UNICEF. Improving child nutrition: The achievable imperative for global progress. 2013. Report No.: Contract No.
3.
Ozaltin E, Hill K, Subramanian SV. Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. JAMA. 2010;303(15):1507–16.CrossRefPubMedPubMedCentral
4.
Martorell R, Horta BL, Adair LS, Stein AD, Richter L, Fall CH, Bhargava SK, Biswas SK, Perez L, Barros FC, et al. Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries. J Nutr. 2010;140(2):348–54.CrossRefPubMedPubMedCentral
5.
Martorell R, Khan LK, Schroeder DG. Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr. 1994;48(Suppl 1):S45–57.PubMed
6.
Thomas D, Strauss J. Health and wages: evidence on men and women in urban Brazil. J Econom. 1997;77:159–85.CrossRefPubMed
7.
8.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS. Maternal, child undernutrition study G. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.CrossRefPubMedPubMedCentral
9.
10.
Martorell R, Zongrone A. Intergenerational influences on child growth and undernutrition. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):302–14.CrossRefPubMed
11.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey. Dhaka, Bangladesh, and Rockville; 2016. Report No.: Contract No; 2014.
12.
Headey D, Hoddinott J, Park S. Drivers of nutritional change in four South Asian countries: a dynamic observational analysis. Matern Child Nutr. 2016;12(Suppl 1):210–8.CrossRefPubMedPubMedCentral
13.
14.
Scaling up Nutrition. A Framework for Action. Food Nutr Bull. 2010;31(1):178–86.
15.
McGuire S. World Health Organization. Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition. Geneva, Switzerland, 2014. Adv Nutr Intl Rev J. 2015;6(1):134–5.CrossRef
16.
17.
Murray CJL. Shifting to Sustainable development goals — implications for Global Health. N Engl J Med. 2015;373(15):1390–3.CrossRefPubMed
18.
Christian P, Lee SE, Donahue Angel M, Adair LS, Arifeen SE, Ashorn P, Barros FC, Fall CH, Fawzi WW, Hao W, et al. Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries. Int J Epidemiol. 2013;42(5):1340–55.CrossRefPubMedPubMedCentral
19.
Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473–80.CrossRefPubMed
20.
Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013;9(Suppl 2):27–45.CrossRefPubMed
21.
Dewey KG, Mayers DR. Early child growth: how do nutrition and infection interact? Matern Child Nutr. 2011;7(Suppl 3):129–42.CrossRefPubMed
22.
Garza C, Borghi E, Onyango AW, de Onis M, Group WHOMGRS. Parental height and child growth from birth to 2 years in the WHO Multicentre growth reference study. Matern Child Nutr. 2013;9(Suppl 2):58–68.CrossRefPubMed
23.
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. Lancet nutrition interventions review G et al. evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77.CrossRefPubMed
24.
25.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey. Dhaka, Bangladesh and Calverton: NIPORT, Mitra and Associates, and ICF international; 2013. Report No.: Contract No; 2011.
26.
Carine A. Bellera BJF, James A. Hanley Calculating sample size in anthropometry. In: Preedy VR editor. Handbook of Anthropometry: Physical Measures of Human Form in Health and Diseases. Volume 1–6. 2012. p. 3–27.
27.
28.
Ministry of Health GoB. Infant and Young Child Feeding Training Manual (Sub-district and Union level); 2013.
29.
Government of Bangladesh. Maternal and Neonatal Care Counselling Module for Community Health Workers training module; 2011.
30.
Mridha MK, Matias SL, Chaparro CM, Paul RR, Hussain S, Vosti SA, Harding KL, Cummins JR, Day LT, Saha SL, et al. Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh. Am J Clin Nutr. 2016;103(1):236–49.CrossRefPubMed
31.
Saha KK, Billah M, Menon P, El Arifeen S, Mbuya NV. Bangladesh National Nutrition Services: assessment of implementation status: World Bank publications; 2015.
32.
33.
34.
35.
36.
Marías Y, Glasauer P. Guidelines for assessing nutrition-related knowledge, attitudes and practices. 2014.
37.
Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005;5(1):42–52.CrossRefPubMed
38.
de Onis M, Onyango AW, Van den Broeck J, Chumlea WC, Martorell R. Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull. 2004;25(1 Suppl):S27–36.CrossRefPubMed
39.
Metadata
Title
A community-based cluster randomised controlled trial to evaluate the effectiveness of different bundles of nutrition-specific interventions in improving mean length-for-age z score among children at 24 months of age in rural Bangladesh: study protocol
Authors
Sk Masum Billah
Tarana E. Ferdous
Mohd Anisul Karim
Michael J. Dibley
Shahreen Raihana
Md Moinuddin
Nuzhat Choudhury
Tahmeed Ahmed
D. M. Emdadul Hoque
Purnima Menon
Shams El Arifeen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4281-0

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