Impact of an Integrated Agricultural, Nutrition, and Water, Sanitation and Hygiene Intervention during the First 1000 Days on Child Growth and Micronutrient Status in Western Kenya: A Cluster-Randomized Controlled Trial.

BACKGROUND

Agricultural programs alone have shown limited impact on nutritional status.

OBJECTIVES

We hypothesized that linear growth would improve by adding nutrition and water, sanitation and hygiene components to an existing agriculture program, targeting pregnant females and their offspring over the 1000-d window.

METHODS

We conducted a cluster-randomized controlled trial in rural Kenya. Females <20 wk pregnant were randomly assigned to an existing agricultural intervention without (control) or with additional interventions (intervention), provided from enrolment until their child reached 24 mo. Additional interventions included daily small-quantity lipid-based nutrient supplements (SQ-LNS) to females during pregnancy until 6 mo postpartum; micronutrient powders (MNP) and eggs to children; and soap, chlorine solution, and monthly behavior change trainings. The main outcome was length-for-age z-score (LAZ) at 24 mo. Safety was assessed through active morbidity and passive adverse event monitoring. We used mixed-effects generalized linear models for analysis.

RESULTS

Between June and December 2018, 1199 pregnant females from 164 clusters were enrolled (628 intervention and 571 control). Data on LAZ were available for 976 (81.4%) children at 24 mo. Adherence was >75% for SQ-LNS, MNP, eggs, and chlorine, and ∼50% for soap. At 24 mo, mean LAZ [95% confidence interval (CI)] was higher in the intervention group [-0.91 (-1.00, -0.82)] than in the control group [-1.15 (-1.25, -1.06)], with an adjusted effect size (95% CI) of 0.24 (0.11, 0.37), and stunting prevalence was lower [12% compared with 19%, adjusted relative risk: 0.69 (0.50, 0.96)]. LAZ declined less from birth to 24 mo in the intervention group [effect: 0.18 (0.06, 0.31)]. Intervention children showed better iron and vitamin A status at 6 and 24 mo and a lower prevalence of diarrhea at 6 mo; stunting at 6 mo and diarrhea at 24 mo did not differ between groups.

CONCLUSIONS

An integrated intervention during pregnancy and early childhood improved linear growth and micronutrient status and reduced diarrheal disease. This trial was registered at clinicaltrials.gov as NCT03558464 (https://clinicaltrials.gov/study/NCT03558464?locStr=Kenya&country=KE&cond=NCT03558464&aggFilters=status:com&rank=1).