title: Lipid-Based Nutrient Supplements Plus Malaria and Diarrhea Treatment Increase Infant Development Scores in a Cluster-Randomized Trial in Burkina Faso.
abstract: BACKGROUND
  Adequate nutrition is necessary for the rapid brain development that occurs during infancy.
  
  
  OBJECTIVE
  We tested the hypothesis that the provision of small-quantity, lipid-based nutrient supplements (SQ-LNSs) plus malaria and diarrhea treatment positively affects infant development. We also tested the effect of various doses of zinc provided in SQ-LNSs or in a tablet.
  
  
  METHODS
  In a partially masked, cluster-randomized controlled trial, communities in rural Burkina Faso were stratified by selected characteristics and then randomly assigned within strata to the intervention (IC; 25 communities, 2435 children) or the nonintervention (NIC; 9 communities, 785 children) cohorts. IC children were randomly assigned to 4 groups. As secondary outcomes, a subsample of 3 of these 4 groups (n = 747) and of the NIC (n = 376) were assessed for motor, language, and personal-social development at age 18 mo by using the Developmental Milestones Checklist II. The 3 IC groups received 20 g SQ-LNSs/d containing 0 or 10 mg added zinc with a placebo tablet or 20 g SQ-LNSs/d containing 0 mg added zinc with a tablet containing 5 mg Zn. All IC groups received treatment of malaria and diarrhea from age 9 to 18 mo. Data collectors and participants were aware of allocation to the IC or NIC but did not know the particular IC subgroup.
  
  
  RESULTS
  Children in the IC scored 0.34 (95% CI: 0.21, 0.46), 0.30 (95% CI: 0.15, 0.44), and 0.32 (95% CI: 0.16, 0.48) SDs higher in motor, language, and personal-social development, respectively, than did children in the NIC (All P < 0.001). Children who received different amounts of zinc did not differ significantly in any of the scores. No effect on caregiver-child interaction was found.
  
  
  CONCLUSIONS
  In rural Burkina Faso, the provision of SQ-LNSs to infants from age 9 to 18 mo, regardless of added zinc content, plus malaria and diarrhea treatment positively affected motor, language, and personal-social development at age 18 mo. This trial was registered at clinicaltrials.gov as NCT00944281.
authors.affiliation: Department of Nutrition, University of California Davis, Davis, CA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Prado
authors.affiliation: Department of Nutrition, University of California Davis, Davis, CA.
authors.forename: Souheila
authors.initials: S
authors.lastname: Abbeddou
authors.affiliation: Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM.|Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Yakes Jimenez
authors.affiliation: Department of Nutrition, University of California Davis, Davis, CA.|Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (Health Sciences Research Institute/Western Regional Directorate), Bobo-Dioulasso, Burkina Faso.
authors.forename: Jérôme W
authors.initials: JW
authors.lastname: Somé
authors.affiliation: Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (Health Sciences Research Institute/Western Regional Directorate), Bobo-Dioulasso, Burkina Faso.
authors.forename: Zinewendé P
authors.initials: ZP
authors.lastname: Ouédraogo
authors.affiliation: Department of Agricultural and Resource Economics, University of California Davis, Davis, CA.
authors.forename: Steve A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Department of Nutrition, University of California Davis, Davis, CA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: Department of Nutrition, University of California Davis, Davis, CA.|Bill & Melinda Gates Foundation, Seattle, WA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Brown
authors.affiliation: Department of Nutrition, University of California Davis, Davis, CA.
authors.forename: Sonja Y
authors.initials: SY
authors.lastname: Hess
authors.affiliation: Institut de Recherche en Sciences de la Santé/Direction Régionale de l'Ouest (Health Sciences Research Institute/Western Regional Directorate), Bobo-Dioulasso, Burkina Faso.
authors.forename: Jean-Bosco
authors.initials: JB
authors.lastname: Ouédraogo
keywords: diarrhea; infant development; infant nutrition; language development; lipid-based nutrient supplements; malaria; motor development; personal-social development; zinc