Developmental outcomes of an individualised complementary feeding intervention for stunted children: a substudy from a larger randomised controlled trial in Guatemala

Abstract

ObjectiveStunting is a common cause of early child developmental delay; Guatemala has the fourth highest rate of stunting globally. The goal of this study was to examine the impact of an intensive community health worker-led complementary feeding intervention on early child development in Guatemala. We hypothesised that the intervention would improve child development over usual care.DesignA substudy from a larger individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcomes data.SettingRural, indigenous Maya communities in Guatemala.Participants210 stunted children (height-for-age z-score ≤−2.5) aged 6–24 months, previously randomised to usual care (106) or an intensive complementary feeding intervention (104). 84 in the intervention and 91 in the usual care arm agreed to participate.InterventionsCommunity health workers conducted monthly home visits for 6 months, providing usual care or individualised complementary feeding education.Main outcome measuresThe primary outcomes were change in z-scores for the subscales of the Bayley Scales of Infant Development (BSID), Third Edition.Results100 individuals were included in the final analysis, 47 in the intervention and 53 in the usual care arm. No statistically significant differences in age-adjusted scores between the arms were observed for any subscale. However, improvements within-subjects in both arms were observed (median duration between measurements 189 days (IQR 182–189)). Mean change for subscales was 0.45 (95% CI 0.23 to 0.67) z-scores in the intervention, and 0.43 (95% CI 0.25 to 0.61) in the usual care arm.ConclusionsAn intensive complementary feeding intervention did not significantly improve developmental outcomes more than usual care in stunted, indigenous Guatemalan children. However, both interventions had significant positive impacts on developmental outcomes.Trial registration numberNCT02509936.StageResults.

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“…For families receiving the behaviour change intervention, diet diversity improved, including for food groups not provided in the food ration, although improvements in growth were not significant 27. This study also measured developmental outcomes, finding improvements in development in both arms 28…”

“…Using a taxonomy previously described to classify determinants of nutrition (online supplementary table 3), we found two studies that involved interventions on more than one nutrition determinant 25. Both included dietary supplementation with the addition of complementary feeding interventions 26–29. The first was a large, cluster-randomised trial evaluating combinations of family food rations, fortified cereal or micronutrient powder supplements, and behaviour change around complementary feeding practices.…”

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“…Sixty-three percent of women in Guatemala initiate breastfeeding and approximately 53% exclusively breastfeed their infants. 43 The Global Nutrition Report indicates that 82% of infants in Guatemala have meet the WHO Infant and Young Child feeding indicators thresholds for minimum meal frequency, and 59% meet the threshold for minimum dietary diversity. 44 In 2021, Juarez and colleagues 45 demonstrated a 50% prevalence of food insecurity in rural Mayan children.…”

“…These recruitment strategies have been used successfully for several other studies related to early child nutrition and health in the study region. 12,43,54,55 If the recruitment progress is slower than expected through the above channels, the study team will collaborate with MHA's extensive network of local nongovernmental and communitybased organizations to recruit additional participants.…”

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“…1,2 Only around half of Guatemalan children under 2 years of age receive a minimum acceptable diet according to World Health Orga-nization criteria that assess whether the child is being fed an adequate variety of food groups (minimum dietary diversity) and whether the child is being fed often enough (minimum feeding frequency). 2,3 Children's diets generally contain adequate protein and energy, but are typically monotonous, with a high proportion of carbohydrates and limited animalsource foods. 4 The typical diet is deficient in multiple micronutrients, especially zinc and iron.…”