Nutrition

Associations between exposure to nutrition, WASH interventions and children’s academic performance in Ethiopia: A systematic review and meta-analysis

Background Poor nutrition and inadequate WASH (water, sanitation, and hygiene) practices significantly impact children’s health, nutrition, and cognitive development, especially in low-income settings. These factors further aggravate the incidence of undernutrition, weaken the immune system, increase susceptibility to illnesses and reduce cognitive performance. Evidence on the effectiveness of existing WASH interventions is needed. Objective This review evaluated the effectiveness of nutritional and WASH interventions on the academic performance of children in Ethiopia. Methods A systematic search of Cochrane, DOAJ, Google Scholar, and PubMed (2010–2024) was conducted using MeSH terms and keywords related to WASH. Two independent reviewers screened studies and extracted data. Eligible studies included cross-sectional and cohort studies on Ethiopian schoolchildren with quantifiable academic outcomes. The JBI SUMARI was used to assess bias, and the GRADE approach was used to evaluate evidence quality. The meta-analysis used a random-effects model in Stata and reported pooled RRs with 95% CIs. Subgroup and sensitivity analyses examined moderators such as study design, intervention type, and sample size. Results A total of 19 studies, 16 cross-sectional (n= 16) and three prospective (n= 3) cohort studies with a total of 9034 participants, were included. The random effects model revealed a significant improvement in academic performance among students receiving both nutrition and WASH, with a pooled large positive effect size of 2.05 (95% CI: 1.26, 2.28; I2=). In the subgroup meta-analysis, the effect of the intervention was more positive among those who skipped breakfast (3.47, 95% CI: 0.47, 6.47), chronic iodine deficiency (4.49, 95% CI: 4.08, 4.90), food insecurity (2.810, 95% CI: 1.281, 4.339), and underweight (0.61, 95% CI: 0.46, 0.75). Conclusion Despite moderate variability and some risk of bias, the evidence supports the integration of comprehensive nutrition and WASH programs into school health initiatives. Future research should focus on long-term effects and cost-effectiveness.

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.

Food supply implications of healthy diet consumption in Senegal by 2050