Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe
Introduction HIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes.Methods Sanitation Hygiene Infant Nutrition...
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BMJ Publishing Group
2020-01-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/1/e001718.full |
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| author | Lawrence H Moulton Melissa Gladstone Jaya Chandna Robert Ntozini Kuda Mutasa Jean H Humphrey Andrew J Prendergast Bernard Chasekwa Ceri Evans Gwendoline Kandawasvika Batsirai Mutasa Florence D Majo Naume V Tavengwa Mduduzi NN Mbuya |
| author_facet | Lawrence H Moulton Melissa Gladstone Jaya Chandna Robert Ntozini Kuda Mutasa Jean H Humphrey Andrew J Prendergast Bernard Chasekwa Ceri Evans Gwendoline Kandawasvika Batsirai Mutasa Florence D Majo Naume V Tavengwa Mduduzi NN Mbuya |
| author_sort | Lawrence H Moulton |
| collection | DOAJ |
| description | Introduction HIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes.Methods Sanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.gov NCT01824940). Pregnant women were eligible if they lived in study clusters allocated to standard-of-care (SOC; 52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement/day from 6 to 18 months, complementary feeding counselling; 53 clusters); WASH (pit latrine, 2 hand-washing stations, liquid soap, chlorine, play space, hygiene counselling; 53 clusters) or IYCF +WASH (53 clusters). Participants and fieldworkers were not blinded. ECD was assessed at 24 months using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social skills); MacArthur Bates Communication Development Inventories (assessing vocabulary and grammar); A-not-B test (assessing object permanence) and a self-control task. Intention-to-treat analyses were stratified by maternal HIV status.Results Compared with SOC, children randomised to combined IYCF +WASH had higher total MDAT scores (mean difference +4.6; 95% CI 1.9 to 7.2) and MacArthur Bates vocabulary scores (+8.5 words; 95% CI 3.7 to 13.3), but there was no evidence of effects from IYCF or WASH alone. There was no evidence that that any intervention impacted object permanence or self-control.Conclusions Combining IYCF and WASH interventions significantly improved motor, language and cognitive development in HIV-exposed children.Trial registration number NCT01824940. |
| format | Article |
| id | doaj-art-68ee176448c741ca88b40ef92b29401c |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-68ee176448c741ca88b40ef92b29401c2025-08-20T02:50:00ZengBMJ Publishing GroupBMJ Global Health2059-79082020-01-015110.1136/bmjgh-2019-001718Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural ZimbabweLawrence H Moulton0Melissa Gladstone1Jaya Chandna2Robert Ntozini3Kuda Mutasa4Jean H Humphrey5Andrew J Prendergast6Bernard Chasekwa7Ceri Evans8Gwendoline Kandawasvika9Batsirai Mutasa10Florence D Majo11Naume V Tavengwa12Mduduzi NN Mbuya134 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UKDepartment of Women and Child Health, University of Liverpool, Liverpool, UK3 Research Team, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe3 Research Team, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabweassociate professor of international health3 Research Team, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe3 Research Team, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe1 GenitoUrinary and HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKUniversity of Zimbabwe College of Health Sciences, Harare, ZimbabweZvitambo Institute for Maternal and Child Health research, Harare, Zimbabwe3 Research Team, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe3 Research Team, Zvitambo Institute for Maternal and Child Health Research, Harare, ZimbabweGlobal Alliance for Improved Nutrition, Washington, DC, USAIntroduction HIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes.Methods Sanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.gov NCT01824940). Pregnant women were eligible if they lived in study clusters allocated to standard-of-care (SOC; 52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement/day from 6 to 18 months, complementary feeding counselling; 53 clusters); WASH (pit latrine, 2 hand-washing stations, liquid soap, chlorine, play space, hygiene counselling; 53 clusters) or IYCF +WASH (53 clusters). Participants and fieldworkers were not blinded. ECD was assessed at 24 months using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social skills); MacArthur Bates Communication Development Inventories (assessing vocabulary and grammar); A-not-B test (assessing object permanence) and a self-control task. Intention-to-treat analyses were stratified by maternal HIV status.Results Compared with SOC, children randomised to combined IYCF +WASH had higher total MDAT scores (mean difference +4.6; 95% CI 1.9 to 7.2) and MacArthur Bates vocabulary scores (+8.5 words; 95% CI 3.7 to 13.3), but there was no evidence of effects from IYCF or WASH alone. There was no evidence that that any intervention impacted object permanence or self-control.Conclusions Combining IYCF and WASH interventions significantly improved motor, language and cognitive development in HIV-exposed children.Trial registration number NCT01824940.https://gh.bmj.com/content/5/1/e001718.full |
| spellingShingle | Lawrence H Moulton Melissa Gladstone Jaya Chandna Robert Ntozini Kuda Mutasa Jean H Humphrey Andrew J Prendergast Bernard Chasekwa Ceri Evans Gwendoline Kandawasvika Batsirai Mutasa Florence D Majo Naume V Tavengwa Mduduzi NN Mbuya Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe BMJ Global Health |
| title | Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe |
| title_full | Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe |
| title_fullStr | Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe |
| title_full_unstemmed | Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe |
| title_short | Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe |
| title_sort | effects of improved complementary feeding and improved water sanitation and hygiene on early child development among hiv exposed children substudy of a cluster randomised trial in rural zimbabwe |
| url | https://gh.bmj.com/content/5/1/e001718.full |
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