Independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved complementary feeding on early neurodevelopment among children born to HIV-negative mothers in rural Zimbabwe: Substudy of a cluster-randomized trial

Gladstone, Melissa; Chandna, Jaya; Kandawasvika, Gwendoline; Ntozini, Robert; Majo, Florence D; Tavengwa, Naume V.; Mbuya, Mduduzi N N; Mangwadu, Goldberg; Chigumira, Ancikaria; Chasokela, Cynthia; Moulton, Lawrence H.; Stoltzfus, Rebecca J.; Humphrey, Jean H.; Prendergast, Andrew J.; Team, Shine Trial

doi:10.1371/journal.pmed.1002766

Cited by 43 publications

(44 citation statements)

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“…Among 5280 enrolled pregnant women, there were 738 HIV‐exposed and 3989 HIV‐unexposed live births; of these, 323 HIV‐exposed and 1655 CHU were assessed in the ECD sub‐study at two years of age (Figure ). Mothers of children included in the ECD sub‐study were about two years older compared to mothers of those not included; other baseline characteristics were broadly similar (as reported previously and shown in Table ).…”

Section: Resultssupporting

confidence: 60%

“…Overall, 5280 pregnant women were recruited from 211 clusters at a median gestational age of 12.5 weeks and randomized to standard‐of‐care (SOC); IYCF (20 g small‐quantity lipid‐based nutrient supplement (SQ‐LNS) per day from six to eighteen months of age, complementary feeding counselling); WASH (ventilated improved pit latrine and 2 hand‐washing stations, monthly liquid soap and chlorine, a play‐space to separate children from livestock and to reduce geophagia, hygiene counselling); or IYCF plus WASH (all interventions). The primary findings and ECD findings among a subgroup of children at 24 months have been reported previously, stratified by maternal HIV status .…”

Section: Methodsmentioning

confidence: 61%

“…We used several different developmental assessment tools across a broad range of domains, and specifically adapted them for use in rural Zimbabwe (for example, all toys were bought locally and therefore likely to be familiar to children). The MacArthur Bates CDI is a detailed assessment of language, including both vocabulary and grammar, and we adapted and validated the assessment for use among Shona‐speaking households. We also undertook rigorous quality control throughout the study period, to optimize reliability.…”

Section: Discussionmentioning

confidence: 99%

“…The purpose of this analysis was to estimate the differences in ECD outcomes at 24 months of age between CHEU and CHU. We have previously reported the effects of the randomized SHINE interventions, which differed between these two groups of children . Among CHU, there was little evidence of effect of either intervention on any measure of child development; by contrast, among CHEU, there were large benefits of the combined IYCF plus WASH intervention on MDAT and MacArthur CDI vocabulary scores, but no evidence of effects from either the IYCF or WASH intervention when implemented alone.…”

Section: Methodsmentioning

confidence: 99%

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Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

et al. 2020

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Introduction Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV‐exposed uninfected (CHEU) and children who were HIV‐unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe. Methods SHINE was a community‐based cluster‐randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub‐study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur‐Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A‐not‐B test (assessing object permanence); and a self‐control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster‐randomized design. Primary results were adjusted for trial‐related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm. Results A total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference −1.3, 95% CI: −2.3, −0.3), driven mostly by differences in gross motor (−0.5, 95% CI: −0.9, −0.2) and language scores (−0.6, 95% CI: −1.1, −0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference −0.4, 95% CI: −0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: −0.2, 0.4). Mean MacArthur‐Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference −2.9 words, 95% CI: −5.7, −0.1). Object permanence and self‐control scores were similar between groups. Conclusions CHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term.

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Section: Resultssupporting

confidence: 60%

Section: Methodsmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

et al. 2020

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“…We calculated pooled effect sizes if at least five studies reported an intervention versus control group comparison in any category of intervention (eg, nutritional supplementation and promotion of responsive care and learning opportunities). We applied the same criterion to stratified 29 Ong et al 37 Jeon et al 41 Lind et al 31 Rosado et al 15 Oelofse et al 52 Nahar et al 48 Smuts et al 62 Husaini et al 50 Phuka et al 21 Maleta et al 17 Krebs et al 54 Bauserman et al 55 Faber et al 14 Hess et al 16 Dewey et al 20 77 Luby et al 23 Stewart et al 22 Gladstone et al 61 Lees et al 80 Hallamaa et al 82 Tomlinson et al 78 Tumwine et al 79 Dewey et al 20 Adu-Afarwuah et al 18 Ashorn et al 19 Zhang et al 59 Thomas et al 60 Gowachirapant et al 51 Hamadani et al 35 Jacobson et al 58 Schmidt et al 53 Hanieh 36 Zhu et al 56 Nguyen et al 34 Christian et al 40 Gonzalez-Casano 87 Tofail et al 49 In utero 3 6 9 12 15 18 Months Years 64 Nahar et al 48 Hamadani et al 70 Tofail et al…”

Section: Data Collection and Analysismentioning

confidence: 99%

Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis

Prado

Larson

Cox

et al. 2019

The Lancet Global Health

138

146

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Background Faltering in linear growth and neurobehavioural development during early childhood are often assumed to have common causes because of their consistent association. This notion has contributed to a global focus on the promotion of nutrition during pregnancy and childhood to improve both conditions. Our aim was to assess whether effects of interventions on linear growth are associated with effects on developmental scores and to quantify these associations.Methods In this systematic review and meta-analysis, we included randomised trials done during pregnancy and in children aged 0-5 years that reported effects of any intervention on length-for-age or height-for-age Z scores (LAZ or HAZ) and on any of the following outcomes: motor, cognitive or mental, language, and social-emotional or behavioural development. We searched MEDLINE (Ovid), CINAHL (EBSCO), and PsycINFO (EBSCO) from database inception to June 25, 2019. Study-level data were extracted and, when required, authors were contacted for missing information. We calculated weighted meta-regression coefficients of the association between standardised effect sizes of interventions on LAZ or HAZ and developmental outcome scores and calculated pooled effect sizes for different types of intervention.Findings Of the 7207 studies identified, we included 75 studies with 122 comparisons between intervention and control groups and outcomes reported for 72 275 children. Across all interventions, effect sizes on LAZ or HAZ were significantly associated with effect sizes on social-emotional scores (β 0·23, 95% CI 0·05 to 0·41; p=0·02), but not on cognitive (0·18, -0·36 to 0·72; p=0·51), language (0·12, -0·07 to 0·31; p=0·21), or motor development scores (0·23, -0·05 to 0·50; p=0·11). In studies that provided nutritional supplements, we observed positive significant pooled effect sizes on all five outcomes of LAZ or HAZ (effect size 0·05, 95% CI 0·01-0·09; p=0·01; n=50), cognitive or mental (0·06, 0·03-0·10; p<0·01; n=38), language (0·08, 0·03-0·13; p=0·01; n=21), motor (0·08, 0·04-0·12; p<0·01; n=41), and social-emotional (0·07, 0·02-0·12; p=0·01; n=20) scores. The effect sizes of nutritional supplementation on LAZ or HAZ scores were significantly associated with effect sizes on cognitive (β 0·40, 95% CI 0·04-0·77; p=0·049) and motor (0·43, 0·11-0·75; p=0·01) scores. In the 14 interventions promoting responsive care and learning opportunities, the pooled effect size on LAZ or HAZ score was not significant (-0·01, 95% CI -0·07 to 0·05; p=0·74), but pooled effect sizes on cognitive, language, and motor scores were 4 to 5 times larger (range 0·38-0·48) than the pooled effect sizes of nutritional supplementation (0·05-0·08). Interpretation In nutritional supplementation interventions, improvements in linear growth were associated with small improvements in child development, whereas nurturing and stimulation interventions had significant effects on child development but no effectson linear growth. The determinants of linear growth and neurodevelopment are only partly ...

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The toll of household water insecurity on health and human biology: Current understandings and future directions

Rosinger

Young

2020

WIREs Water

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Water is imperative for nutrition and health, economic productivity, and political stability; it also holds cultural and symbolic meanings and functions. Household water insecurity is an emerging construct that captures lived experiences with water access, use, and acceptability. Although the plausibility of household water insecurity to "get under the skin" and shape human biology is high, these relationships have not been systematically investigated. Therefore, in this article, we set out to examine how household water insecurity and allied concepts affect health and human biology throughout the life course. We first lay out the various ways that water insecurity can act as a deleterious exposure, that is, through problematic quality, excess, and shortage. Next, we posit how water insecurity directly shapes human biology, as well as indirectly, via psychosocial stress precipitating cortisol exposure, with potential intergenerational effects. We highlight a range of established and plausible biological consequences using evidence from human and animal model studies. These include diarrheal prevalence, dehydration, stunting, food insecurity, gut microbiome alteration, malnutrition, psychosocial stress, adverse birth outcomes, lower cognitive function and performance, hypertension, and chronic kidney disease. We also discuss the mechanisms by which household water insecurity may shape human biology across the life course; however, these pathways are just beginning to be understood. Longitudinal studies that simultaneously quantify household water insecurity and biological outcomes using comparable metrics in diverse environments and across generations will provide necessary evidence to establish causal relationships. Given the current global water crisis and its potential health consequences, such studies are urgently needed.

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Independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved complementary feeding on early neurodevelopment among children born to HIV-negative mothers in rural Zimbabwe: Substudy of a cluster-randomized trial

Cited by 43 publications

References 47 publications

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis

The toll of household water insecurity on health and human biology: Current understandings and future directions

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