The Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia
Condition: Stunting
MeSH terms: Growth Disorders
Study type: Interventional

Summary: 
      According to the latest estimates, 144 million children under age five experience growth
      faltering. Early life growth faltering or stunting is predictive of a wide array of negative
      long-term outcomes, including reduced adult height and productivity, diminished health and
      reduced lifetime incomes.

      This study builds on a previous pilot study, which suggests that providing parents with tools
      to measure children's growth at home may be an effective way to prevent early life growth
      faltering. The objectives of this study are to assess 1) the impact of growth charts on early
      childhood linear growth; and 2) whether the impact of growth charts can be increased with the
      provision of food supplements to parents.
    

Detailed description: 
      More than 250 million children under the age of five are currently estimated to not reach
      their developmental potential due to poverty, malnutrition and infectious diseases. According
      to the latest estimates, 21% of children under age 5 in LMICs are more than two standard
      deviations shorter than the global reference median and thus considered stunted according to
      WHO guidelines. Early life growth faltering interferes with children's ability to learn and
      has been associated with reduced subsequent development and physical growth. Stunting has
      also been linked to delayed school enrollment, reduced educational attainment, poor health,
      and decreased well-being.

      There is a growing consensus among scientists, the global public health and development
      community as well as among governments that addressing stunting is a top priority for
      promoting children's development and well being, and for increasing children's future
      economic potential. While a large literature has highlighted the importance of favorable
      environmental and socioeconomic factors for the prevention of early growth faltering,
      effective interventions to reduce growth faltering in low income settings remain scarce.
      Among families of affected children, stunting often goes unrecognized in communities where
      growth faltering is common. Even children with substantial delays in their physical
      development may be perceived as of normal size in comparison to peer children in their
      community. In many Low and Middle Income Countries (LMICs), height measurements are not
      routinely conducted as part of child health checkups. In Zambia, many parents were found to
      be unaware of their child's growth deficits, which makes it difficult for them to act to
      combat chronic malnutrition and stunting.

      In a previous pilot study, the investigator team found that simple growth charts installed at
      children's homes can be an effective tool for increasing parental awareness of children's
      nutritional need and growth trajectories. The objective of this trial is thus to rigorously
      assess these growth charts through a cluster-randomized controlled trial to be conducted in
      three districts of Zambia. Given that larger improvements in height may only be possible with
      additional nutritional input in this setting, the trial will also assess the extent to which
      early life growth can be improved through the provision of lipid-based nutrient supplements
      (LNS).

      The overall objective of this project is to assess the impact of growth charts as well as
      nutritional supplements on children's physical growth in a representative sample of Zambia
      communities. This larger objective can be divided into three specific aims:

      Specific Aim 1: Assess the impact of growth charts installed in children's homes on
      children's physical growth.

      Specific Aim 2: Assess the extent to which growth trajectories can be modified through the
      provision of LNS.

      Specific Aim 3: Assess the extent to which growth trajectories can be modified through the
      joint provision of LNS and home-installed growth charts
    

Intervention name(s): Lipid based nutrient Supplements (LNS):; Growth Charts
Intervention type(s): Dietary Supplement; Device
Intervention description(s): LNS are 20 g/~110 calorie nutrient supplements that provide energy, protein, essential fatty acids and a wide range of micronutrients critical for children ages 6 to 24 months of age. They are designed to complement diets without displacing breastmilk and local dietary preferences and can be mixed into the child's meal or eaten directly from the sachet.; Growth charts have been locally developed to allow parents an easy assessment of their children's height at their home. Charts will be placed on walls inside homes and will provide parents the opportunity to measure their child whenever they want, and will also contain information on the most suitable local foods as well as the importance of diverse diets and frequent feeding.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study used a 2x2 factorial design testing growth charts and supplements.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention