Lilia Bliznashka

Adding small quantity lipid-based nutrient supplements to an enhanced homestead food production program improves child hemoglobin, iron and vitamin A status in rural Burkina Faso: A cluster randomized controlled trial

Background Enhanced homestead food production programs (EHFP) including nutrition behavior change communication and women’s empowerment activities have limited impacts on child nutrition. This may be due to short program duration or the absence of interventions to improve water, sanitation, and hygiene (WASH) and access to nutritious foods. Objective We assessed impacts on child anemia, micronutrient status and anthropometry of prior village exposure to an EHFP, and of adding WASH alone or WASH with daily small quantity-lipid based nutrient supplements (SQ-LNS). Design This 2y longitudinal cluster-randomized controlled trial (2014-2016) included 60 villages in Burkina Faso randomized to four groups (15 per group): (1) EHFP-2014, (2) EHFP-2014+WASH, (3) EHFP-2010+WASH, and (4) EHFP-2010+WASH+SQ-LNS. Groups 3 and 4 had previously received EHFP (2010-2012). We assessed impacts on child anemia and micronutrient status (n=1,704; 3-12.9 mo at baseline) and anthropometry (n=2,308; 0-12.9 mo at baseline) using difference-in-difference (DID) specifications. We controlled for covariates, adjusted for clustering, and assessed interactive effects by child age at baseline. The trial was registered with clinicaltrials.gov (NCT02236468). Results We found no impact of prior exposure to EHFP (groups 2 vs 3) on the outcomes examined. Adding WASH (groups 1 vs 2) reduced anemia (hemoglobin (Hb)<11 g/dL) (DID=9.43 pp, p<0.01) and led to a decline in weight-for-age Z-score (WAZ) (DID -0.11±0.04, p=0.01). Adding SQ-LNS (groups 3 vs 4) increased Hb (DID=0.26±0.13 g/dL, p<0.05), plasma ferritin (DID=7.61±2.69 μg/L, p<0.01), and retinol binding protein (DID=0.07±0.02 umol/L, p<0.01) concentrations. Effects were larger in children <6 mo at baseline, where providing SQ-LNS (>6 mo) positively impacted Hb, plasma ferritin, height-for-age Z-score, WAZ, and underweight. Conclusions Using EHFP to deliver WASH and SQ-LNS reduced child anemia and improved micronutrient status. Anthropometric improvements were found in children who joined the program before 6 mo of age and were exposed for the whole complementary feeding period.

Relevance of more stringent discharge standards for acute malnutrition treatment: A pooled analysis of post-treatment relapse in 21 studies

Fruit intake among women of reproductive age in northern Tanzania: Baseline findings from the FRESH end-to-end evaluation

To ensure overall health and reduce risk of non-communicable disease (NCDs), a healthy diet low in fat, sugars and salt and high in fruit and vegetables (F&V) is recommended. In most population groups, however, F&V intake is below the World Health Organization (WHO) recommendation of 400 g per person/day. In Tanzania, a recent scoping review found that F&V intake was below recommended levels in all population groups examined. Low F&V intake is due to a complex interplay of desirability, affordability, accessibility and availability. The CGIAR Research Initiative on Fruit and Vegetables for Sustainable Healthy Diets (FRESH), now under the CGIAR Science Program on Better Diets and Nutrition (BDN), is designing an end-to-end approach to be evaluated in Northern Tanzania, as previously described in the Research Brief 1. A baseline survey was implemented, and dietary intake and nutrient adequacies among women of reproductive age (WRA, 15-49 years of age) participating in the baseline survey were summarized elsewhere. Here we provide a deep dive into fruit intake among these women.