Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial.
BACKGROUND
Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age. Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition.


METHODS
We used a cluster randomised trial to compare two World Vision programmes for maternal and child health and nutrition, which included a behaviour change and communication component: a preventive model, targeting all children aged 6-23 months; and a recuperative model, targeting underweight (weight-for-age Z score <-2) children aged 6-60 months. Both models also targeted pregnant and lactating women. Clusters of communities (n=20) were paired on access to services and other factors and were randomly assigned to each model. Using two cross-sectional surveys (at baseline and 3 years later), we tested differences in undernutrition in children aged 12-41 months (roughly 1500 children per survey). Analyses were by intention to treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. This study is registered with ClinicalTrials.gov, number NCT00210418.


RESULTS
There were no differences between programme groups at baseline. At follow-up, stunting, underweight, and wasting (using WHO 2006 reference data) were 4-6 percentage points lower in preventive than in recuperative communities; and mean anthropometric indicators were higher by +0.14 Z scores (height for age; p=0.07), and +0.24 Z scores (weight for age and weight for height; p<0.0001). The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter durations during this period. The quality of implementation did not differ between the two programmes; nor did use of services for maternal and child health and nutrition.


CONCLUSIONS
The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model.
Ruel
Marie T
MT
Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006, USA. m.ruel@cgiar.org
Menon
Purnima
P
Habicht
Jean-Pierre
JP
Loechl
Cornelia
C
Bergeron
Gilles
G
Pelto
Gretel
G
Arimond
Mary
M
Maluccio
John
J
Michaud
Lesly
L
Hankebo
Bekele
B
D049628:Body Size; D002662:Child Health Services; D015362:Child Nutrition Disorders / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D002675:Child, Preschool; D005247:Feeding Behavior; D005260:Female; D005522:Food Services; D006128:Growth; D006205:Haiti / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D008427:Maternal Health Services; D009752:Nutritional Status; D011247:Pregnancy; D015995:Prevalence; D011314:Preventive Health Services; D013851:Thinness / Q000178:diet therapy*