- © 2017 American Society for Nutrition
Large-Scale Behavior-Change Initiative for Infant and Young Child Feeding Advanced Language and Motor Development in a Cluster-Randomized Program Evaluation in Bangladesh1,2,3
- Edward A Frongillo4,*,
- Phuong H Nguyen5,
- Kuntal K Saha5,
- Tina Sanghvi6,
- Kaosar Afsana7,
- Raisul Haque7,
- Jean Baker6,
- Marie T Ruel5,
- Rahul Rawat5, and
- Purnima Menon5
- 4University of South Carolina, Columbia, SC;
- 5Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC;
- 6Alive & Thrive, Washington, DC; and
- 7BRAC, Dhaka, Bangladesh
- ↵*To whom correspondence should be addressed. E-mail: efrongillo{at}sc.edu.
Abstract
Background: Promoting adequate nutrition through interventions to improve infant and young child feeding (IYCF) has the potential to contribute to child development.
Objective: We examined whether an intensive intervention package that was aimed at improving IYCF at scale through the Alive & Thrive initiative in Bangladesh also advanced language and gross motor development, and whether advancements in language and gross motor development were explained through improved complementary feeding.
Methods: A cluster-randomized design compared 2 intervention packages: intensive interpersonal counseling on IYCF, mass media campaign, and community mobilization (intensive) compared with usual nutrition counseling and mass media campaign (nonintensive). Twenty subdistricts were randomly assigned to receive either the intensive or the nonintensive intervention. Household surveys were conducted at baseline (2010) and at endline (2014) in the same communities (n = ∼4000 children aged 0–47.9 mo for each round). Child development was measured by asking mothers if their child had reached each of multiple milestones, with some observed. Linear regression accounting for clustering was used to derive difference-in-differences (DID) impact estimates, and path analysis was used to examine developmental advancement through indicators of improved IYCF and other factors.
Results: The DID in language development between intensive and nonintensive groups was 1.05 milestones (P = 0.001) among children aged 6–23.9 mo and 0.76 milestones (P = 0.038) among children aged 24–47.9 mo. For gross motor development, the DID was 0.85 milestones (P = 0.035) among children aged 6–23.9 mo. The differences observed corresponded to age- and sex-adjusted effect sizes of 0.35 for language and 0.23 for gross motor development. Developmental advancement at 6–23.9 mo was partially explained through improved minimum dietary diversity and the consumption of iron-rich food.
Conclusions: Intensive IYCF intervention differentially advanced language and gross motor development, which was partially explained through improved complementary feeding. Measuring a diverse set of child outcomes, including functional outcomes such as child development, is important when evaluating integrated nutrition programs. This trial was registered at clinicaltrials.gov as NCT01678716.
- gross motor development
- language development
- interpersonal counseling
- mass media
- child undernutrition
- cluster randomized trial
- effectiveness evaluation
- Bangladesh
Footnotes
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↵1 Supported by the Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360; Consultative Group for International Agricultural Research (CGIAR) Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute. This is a free access article, distributed under terms (http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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↵2 Author disclosures: EA Frongillo, PH Nguyen, KK Saha, T Sanghvi, K Afsana, R Haque, J Baker, MT Ruel, R Rawat, and P Menon, no conflicts of interest. The Gates Foundation and Alive & Thrive (A&T) participated in the study design choices; neither participated in the data collection or analysis. A&T provided specific written inputs to the manuscript on intervention design and provided feedback on interpretation of the results. A&T and the Gates Foundation gave extensive feedback at all stages of the project, but freedom to publish the study findings was protected contractually in the agreement between the respective funding sources and the International Food Policy Research Institute. All final decisions on the manuscript were made by the researchers.
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↵3 Supplemental Table 1 is available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.
- Manuscript received: August 19, 2016.
- Initial review completed: September 14, 2016.
- Revision accepted: December 5, 2016.
This is a free access article, distributed under terms (http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
