title: Mineral- and vitamin-enhanced micronutrient powder reduces stunting in full-term low-birth-weight infants receiving nutrition, health, and hygiene education: a 2 × 2 factorial, cluster-randomized trial in Bangladesh.
abstract: BACKGROUND
  The causes of stunting are complex but likely include prenatal effects, inadequate postnatal nutrient intake, and recurrent infections. Low-birth-weight (LBW) infants are at high risk of stunting. More than 25% of live births in low- and middle-income countries are at full term with low birth weight (FT-LBW). Evidence on the efficacy of specific interventions to enhance growth in this vulnerable group remains scant.
  
  
  OBJECTIVE
  We investigated the independent and combined effects of a directed use of a water-based hand sanitizer (HS) and a mineral- and vitamin-enhanced micronutrient powder (MNP) (22 minerals and vitamins) to prevent infections and improve nutrient intake to reduce stunting in FT-LBW infants.
  
  
  METHODS
  The study was a prospective 2 × 2 factorial, cluster-randomized trial in 467 FT-LBW infants during 2 periods: from 0 to 5 mo postpartum (0-180 d postpartum) and from 6 to 12 mo postpartum (181-360 d postpartum) with the use of 48 clusters. All groups received the same general nutrition, health, and hygiene education (NHHE) at enrollment and throughout the 12 mo. Group assignments initially included the following 2 groups: no HS (control) group or HS from 0 to 5 mo postpartum. These assignments were followed by further divisions into the following 4 groups from 6 to 12 mo postpartum: 1) no HS and no MNP (control), 2) HS only, 3) MNP only, and 4) HS and MNP.
  
  
  RESULTS
  When delivered in combination with NHHE, the use of an HS showed no additional benefit in reducing indicators of infection in the first or second half of infancy or the likelihood of stunting at 12 mo postpartum. FT-LBW infants who received the MNP (with or without the HS) were significantly less likely to be stunted at 12 mo than were controls (OR: 0.35; 95% CI: 0.15, 0.84; P = 0.017).
  
  
  CONCLUSIONS
  The use of a mineral- and vitamin-enhanced MNP significantly reduced stunting in FT-LBW infants in this high-risk setting. The use of a water-based HS did not have an additive effect. This trial was registered at clinicaltrials.gov as NCT01455636.
authors.affiliation: Departments of Nutritional Sciences and Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; and.
authors.forename: Sohana
authors.initials: S
authors.lastname: Shafique
authors.affiliation: Departments of Nutritional Sciences and Department of Anthropology, and Dalla Lana School of Public Health, University of Toronto, Toronto Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; and.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Sellen
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto Canada;
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
authors.affiliation: Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
authors.forename: Chowdhury S
authors.initials: CS
authors.lastname: Jalal
authors.affiliation: Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
authors.forename: Saira P
authors.initials: SP
authors.lastname: Jolly
authors.affiliation: Departments of Nutritional Sciences and Pediatrics, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto Canada; Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; and stanley.zlotkin@sickkids.ca.
authors.forename: Stanley H
authors.initials: SH
authors.lastname: Zlotkin
mesh_terms: D001459:Bangladesh; D016000:Cluster Analysis; D019587:Dietary Supplements; D005260:Female; D006130:Growth Disorders / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight / Q000254:growth & development*; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D009752:Nutritional Status; D049590:Postpartum Period / Q000187:drug effects; D011208:Powders; D011446:Prospective Studies
chemical_list: D018977:Micronutrients; D011208:Powders
keywords: full-term low-birth-weight infant; hand hygiene; hand sanitizer; infants; infection; linear growth; low birth weight; micronutrient powder; minerals and vitamins; stunting