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Global Journal of Endocrinological Metabolism

Effectiveness of Nutrition/Health Behavior Change Communication Training; Micronutrient Supplementation and Lipid-Nutrient Supplements to Improve Child Health in Western Kenya

Submission: April 11, 2018; Published: May 09, 2018

DOI: 10.31031/GJEM.2018.02.000533

ISSN 2637-8019
Volume2 Issue2


Despite robust economic growth in the recent decades; 48% of Kenya’s children under five years are chronically malnourished; i.e. stunted (see KDHS; 2014; UNICEF). Levels of anemia are increasing with 70 percent of children fewer than five years being affected and Kenya has one of the highest under-5 mortality rates in Sub-Saharan Africa. Nearly half of these deaths (43%) account to mild and moderate malnutrition; another 11% are related to severe forms of malnutrition. Stunting in linear growth occurs mainly during the first 1000 days; from conception through 24 months of age. In recognition of this critical period; there have been few evaluations of the growth impact of interventions that cover most of this window. The objective of this study was to evaluate home fortification approaches for preventing maternal and child under nutrition within a community-based health program through Ministry of Health and One Acre Fund Partnership. The research hypothesizes that folic acid and small-quantity lipid-based nutrient supplements (LNS) provided to women during pregnancy and the first 6 months postpartum; LNS provided to their offspring from 6 to24 months of age; or both would result in greater child length-for-age z score (LAZ) at 24 months than iron and folic acid (IFA) provided to women during pregnancy and postpartum plus micronutrient powder (MNP) or no supplementation for their offspring from 6 to 24 months. We conducted a cluster-randomized effectiveness trial with 2 arms: 1) women and children both received LNS (LNS-IFAs group); 2) women received IFAs (IFA group). IFA-group was our control. We enrolled 600 women at 20 weeks of gestation within 10 clusters; each comprising the supervision area of a Community Health Volunteer. Data was collected electronically using Mobile Application and extracted into excel spread sheet for cleaning before analysis. Analyses were primarily performed by using ANCOVA F tests and Tukey-Kramer–corrected pair wise comparisons. Home fortification with small-quantity LNS; during the first 1000 days was analyzed to show any improvement on child linear growth and head size in Siaya County. Infants in the LNS-IFAS group had higher birth weights (2629±408 compared with 2588 ± 413g; P=0.007); weight for-age z scores (-1.48±1.01 compared with -1.59±1.02; P=0.006); head-circumference-for-age z scores (HCZs; -1.26 6 1.08 compared with -1.34 ± 1.12; P=0.028); and body mass index z scores (-1.57±1.05 compared with -1.66±1.03; P=0.005) than those in the IFA group; in adjusted models; the differences in length (47.6 ± 0.07 compared with 47.4±0.04 cm; P=0.043) and LAZ (-1.15 ± 0.04 compared with -1.24±0.02; P=0.035) were also significant. LNS-IFAs reduced the risk of newborn stunting (18.7% compared with 22.6%; RR: 0.83; 95% CI: 0.71; 0.97) and small head size (HCZ ˂-2) (20.7% compared with 24.9%; RR: 0.85; 95% CI: 0.73; 0.98). The effects of LNS-IFA on newborn stunting were greatest in infants born before a 10-weeks interruption in LNS-IFA distribution (n=137; 15.7% compared with 23.6%; adjusted RR: 0.69; 95% CI: 0.53; 0.89) and in infants born to women ≤24y of age or with household food insecurity. Prenatal lipid-based nutrient supplements can improve birth outcomes in Kenyan women; especially those at higher risk of fetal growth restriction

Keywords:Iron and folic acid; Lipid-based nutrient supplements; Head circumference; Mid upper hand circumference; Low birth weight; Newborn stunting; Birth outcomes; Effectiveness

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