title: Integrating nutrition and early child-development interventions among infants and preschoolers in rural India.
abstract: This article describes the development, design, and implementation of an integrated randomized double-masked placebo-controlled trial (Project Grow Smart) that examines how home/preschool fortification with multiple micronutrient powder (MNP) combined with an early child-development intervention affects child development, growth, and micronutrient status among infants and preschoolers in rural India. The 1-year trial has an infant phase (enrollment age: 6-12 months) and a preschool phase (enrollment age: 36-48 months). Infants are individually randomized into one of four groups: placebo, placebo plus early learning, MNP alone, and MNP plus early learning (integrated intervention), conducted through home visits. The preschool phase is a cluster-randomized trial conducted in Anganwadi centers (AWCs), government-run preschools sponsored by the Integrated Child Development System of India. AWCs are randomized into MNP or placebo, with the MNP or placebo mixed into the children's food. The evaluation examines whether the effects of the MNP intervention vary by the quality of the early learning opportunities and communication within the AWCs. Study outcomes include child development, growth, and micronutrient status. Lessons learned during the development, design, and implementation of the integrated trial can be used to guide large-scale policy and programs designed to promote the developmental, educational, and economic potential of children in developing countries.
authors.affiliation: Department of Behavioural Sciences, National Institute of Nutrition, Hyderabad, India.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Fernandez-Rao
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.|Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Hurley
authors.affiliation: Department of Micronutrient Research, National Institute of Nutrition, Hyderabad, India.
authors.forename: Krishnapillai Madhavan
authors.initials: KM
authors.lastname: Nair
authors.affiliation: Department of Biostatistics, National Institute of Nutrition, Hyderabad, India.
authors.forename: Nagalla
authors.initials: N
authors.lastname: Balakrishna
authors.affiliation: National Institute of Nutrition, Hyderabad, India.
authors.forename: Kankipati V
authors.initials: KV
authors.lastname: Radhakrishna
authors.affiliation: Department of Micronutrient Research, National Institute of Nutrition, Hyderabad, India.
authors.forename: Punjal
authors.initials: P
authors.lastname: Ravinder
authors.affiliation: Department of Micronutrient Research, National Institute of Nutrition, Hyderabad, India.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tilton
authors.affiliation: The Micronutrient Initiative, Ottawa, Canada.
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Harding
authors.affiliation: The Mathile Institute for the Advancement of Human Nutrition, Dayton, Ohio.
authors.forename: Greg A
authors.initials: GA
authors.lastname: Reinhart
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
mesh_terms: D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004311:Double-Blind Method; D018479:Early Intervention, Educational; D061345:Early Medical Intervention; D005260:Female; D006304:Health Status; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D009034:Mother-Child Relations; D010348:Patient Care Team; D010865:Pilot Projects; D012424:Rural Population; D000078329:Workforce
chemical_list: D018977:Micronutrients
keywords: early child development; integrated interventions; nutrition