Nutritional status and development in 12-18 months old young children in a post-intervention study

Abstract

Background: Infancy is a critical stage of life for rapid brain growth that requires adequate and proper nutrition. Without proper nutrition, infants may become micronutrient deficient leading to poor growth and cognitive development. Small-quantity lipid-based nutrient supplements (SQ-LNS) are one of the promising strategies to address poor nutrition and micronutrient deficiencies during infancy. The effect of providing daily SQ-LNS from age 6 to 12 months on early child growth and development was investigated in a randomized controlled trial (Tswaka) in the peri-urban Jouberton community in the Matlosana Municipality, Klerksdorp, in North West Province. Objectives: To determine the nutritional status and psycho-motor development at the age of 18 months of children who received a delayed SQ-LNS intervention daily from the age of 12 to 18 months compared to those who received the same intervention daily from the age of 6 to 12 months but no intervention from 12 to 18 months. Design: At age 12 months, children (n=392) who completed the Tswaka randomised controlled trial and whose parents consented were enrolled into the post-intervention study. End results (at 12 months) of the Tswaka trial were used as baseline data for the post-intervention study, and end-line measurements were taken at age 18 months. Measurements taken at age 12 and 18 months were weight, length, haemoglobin (Hb) and psychomotor development outcomes. Weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age z-scores (WAZ) were calculated based on the WHO growth reference standards. For Hb values, a finger prick was done. Children in group 1 and 2 received SQ-LNS products from age 6 to 12 months in the Tswaka trial, but no supplements from age 12 to 18 months in the post-intervention study; while children in group 3 received no supplements from age 6 to 12 months in the Tswaka trial, but SQ-LNS from age 12 to 18 months in the post-intervention study. Results: At age 18 months, the mean Hb concentrations were significantly (p=0.003) higher in the children who received SQ-LNS from age 12 to 18 months (group 3) compared to the two previously exposed groups (groups 1 and 2); and 45.38% in group 3 were anaemic compared to 53.98% in group 1 and 58.67% in group 2. The anthropometric data showed that 53.57% of the children were stunted (LAZ< 2), 6.77% overweight (WLZ > 2), 12.30% underweight (<−2 WAZ) and 0.79% and wasted (<−2 WHZ) at 18 months. Compared to group 2 (previously intervention group at 6-12, now control group), children in group 3 (SQ-LNS group) had higher WAZ (P = 0.027) at 18 months. There was no statistically significant difference on intervention effects for loco-motor development and parental rating scores at 18 months when comparing group 3 with group 1 and 2. However, there was a trend (p=0.086) for an intervention effect for eye-hand coordination in group 2 compared to group 3. Conclusion: The provision of SQ-LNS product as point-of-use fortificant showed improvement in the haemoglobin status of children and may be an effective option for preventing anaemia. This study indicated the need for more trials to be done on this topic. It also demonstrated the need to strengthening optimal infant feeding practices and nutritional intervention in relation to growth and development as it remained a public health concern in our population group.