School-age growth and development following infant feeding and/or water, sanitation, and hygiene interventions in rural Zimbabwe: long-term follow-up of a cluster-randomised trial.

Autor:	Piper JD; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.; Blizard Institute, Queen Mary University of London, London, UK.; London School of Hygiene and Tropical Medicine, London, UK., Mazhanga C; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mwapaura M; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mapako G; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mapurisa I; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mashedze T; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Munyama E; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Kuona M; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mashiri T; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Sibanda K; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Matemavi D; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Tichagwa M; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Nyoni S; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Saidi A; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mangwende M; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mbewe G; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Chidhanguro D; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mpofu E; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Tome J; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Mutasa B; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Chasekwa B; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Njovo H; Ministry of Health and Child Care, Harare, Zimbabwe., Nyachowe C; Ministry of Health and Child Care, Harare, Zimbabwe., Muchekeza M; Ministry of Health and Child Care, Harare, Zimbabwe., Sauramba V; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Gladstone MJ; Institute of Translational Medicine, University of Liverpool, Liverpool, UK., Wells JC; Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK., Allen E; London School of Hygiene and Tropical Medicine, London, UK., Moulton LH; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Smuk M; Blizard Institute, Queen Mary University of London, London, UK., Humphrey JH; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Langhaug LF; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Tavengwa NV; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Ntozini R; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe., Prendergast AJ; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.; Blizard Institute, Queen Mary University of London, London, UK.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2024 Nov 22; Vol. 78, pp. 102946. Date of Electronic Publication: 2024 Nov 22 (Print Publication: 2024).
DOI:	10.1016/j.eclinm.2024.102946
Abstrakt:	Background: Few trials have explored long-term effects of interventions designed to reduce child stunting. We evaluated school-age outcomes in rural Zimbabwean children who received cluster-randomised water, sanitation and hygiene (WASH) and/or infant and young child feeding (IYCF) interventions from pregnancy up to 18 months of age. Methods: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial enrolled pregnant women from two rural Zimbabwean districts (Chirumanzu and Shurugwi) between 2012 and 2015, and cluster-randomised them using a 2 × 2 factorial design to standard-of-care, WASH, IYCF, or combined WASH & IYCF, with a co-primary outcome of height-for-age Z-score and haemoglobin at 18 months (clinicaltrials.govNCT01824940). Children who were HIV-unexposed, age 7 years, and still living in Shurugwi district were eligible for this follow-up study (registered at PACTR 202201828512110) and measured between 1st April 2021 and 30th September 2022. The primary outcome at 7 years was cognitive function using the Kaufman Assessment Battery for Children (KABC-II). Secondary outcomes were executive function, literacy and numeracy, fine motor skills, socioemotional function, handgrip strength, broad jump distance, shuttle-run test distance, anthropometry, lean mass index, and skinfold thicknesses. Study nurses conducting assessments were blinded to intervention arm. Analysis followed a pre-registered statistical analysis plan. Intention-to-treat analyses using generalized estimating equations were used to assess the long-term effects of WASH and IYCF on each outcome, leveraging the factorial trial design. A pre-specified subgroup analysis by child sex was also performed. Findings: Among 3989 HIV-negative women, 3676 children were assessed at age 18 months; of these, 1002 (510 female) were assessed at mean (SD) age 7.3 (0.2) years. There was no effect of IYCF or WASH on the KABC-II score or secondary cognitive outcomes, except a small improvement in socioemotional function in WASH arms (-0.98 points, 95% CI -1.73, -0.22, p = 0.01). Children in IYCF arms had higher handgrip strength (0.28 Kg, 95% CI 0.02, 0.53, p = 0.03); however, in the pre-specified subgroup analysis, improved handgrip strength was seen only in boys (0.53 Kg, 95% CI 0.19, 0.87 p = 0.002). There were no significant effects of either intervention on other outcomes. Interpretation: Early-life IYCF and WASH led to few functional benefits by school-age. Interventions that are more comprehensive, delivered for longer, and include nurturing care should be considered to improve long-term cognitive and physical function. Funding: Wellcome [220671/Z/20/Z, 108065/Z/15/Z]; NIH [R61HD103101]; Thrasher [15250]; and IMMANA [3.02]. Competing Interests: There are no interests to declare from any authors. (© 2024 The Authors.)
Databáze:	MEDLINE
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