title: Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial.
abstract: 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.
authors.affiliation: Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006, USA. m.ruel@cgiar.org
authors.forename: Marie T
authors.initials: MT
authors.lastname: Ruel
authors.forename: Purnima
authors.initials: P
authors.lastname: Menon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Habicht
authors.forename: Cornelia
authors.initials: C
authors.lastname: Loechl
authors.forename: Gilles
authors.initials: G
authors.lastname: Bergeron
authors.forename: Gretel
authors.initials: G
authors.lastname: Pelto
authors.forename: Mary
authors.initials: M
authors.lastname: Arimond
authors.forename: John
authors.initials: J
authors.lastname: Maluccio
authors.forename: Lesly
authors.initials: L
authors.lastname: Michaud
authors.forename: Bekele
authors.initials: B
authors.lastname: Hankebo
mesh_terms: 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*