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. 2022 Dec 30;12(12):e056435.
doi: 10.1136/bmjopen-2021-056435.

Child Health, Agriculture and Integrated Nutrition (CHAIN): protocol for a randomised controlled trial of improved infant and young child feeding in rural Zimbabwe

Laura E Smith  1 , Dexter T Chagwena  2   3 , Claire Bourke  4 , Ruairi Robertson  4 , Shamiso Fernando  5 , Naume V Tavengwa  5 , Jill Cairns  6 , Thokozile Ndhlela  6 , Exhibit Matumbu  5 , Tim Brown  7 , Kavita Datta  7 , Batsirai Mutasa  5 , Alice Tengende  5 , Dzivaidzo Chidhanguro  5 , Lisa Langhaug  5 , Maggie Makanza  5 , Bernard Chasekwa  5 , Kuda Mutasa  8 , Jonathan Swann  9 , Paul Kelly  10 , Robert Ntozini  11 , Andrew Prendergast  7
Affiliations

Child Health, Agriculture and Integrated Nutrition (CHAIN): protocol for a randomised controlled trial of improved infant and young child feeding in rural Zimbabwe

Laura E Smith et al. BMJ Open. .

Abstract

Introduction: Over one-quarter of children in sub-Saharan Africa are stunted; however, commercial supplements only partially meet child nutrient requirements, cannot be sustainably produced, and do not resolve physiological barriers to adequate nutrition (eg, inflammation, microbiome dysbiosis and metabolic dysfunction). Redesigning current infant and young child feeding (IYCF) interventions using locally available foods to improve intake, uptake and utilisation of nutrients could ameliorate underlying pathogenic pathways and improve infant growth during the critical period of complementary feeding, to reduce the global burden of stunting.

Methods and analysis: Child Health Agriculture Integrated Nutrition is an open-label, individual household randomised trial comparing the effects of IYCF versus 'IYCF-plus' on nutrient intake during infancy. The IYCF intervention comprises behaviour change modules to promote infant nutrition delivered by community health workers, plus small-quantity lipid-based nutrient supplements from 6 to 12 months of age which previously reduced stunting at 18 months of age by ~20% in rural Zimbabwe. The 'IYCF-plus' intervention provides these components plus powdered NUA-45 biofortified sugar beans, whole egg powder, moringa leaf powder and provitamin A maize. The trial will enrol 192 infants between 5 and 6 months of age in Shurugwi district, Zimbabwe. Research nurses will collect data plus blood, urine and stool samples at baseline (5-6 months of age) and endline (9-11 months of age). The primary outcome is energy intake, measured by multipass 24-hour dietary recall at 9-11 months of age. Secondary outcomes include nutrient intake, anthropometry and haemoglobin concentration. Nested laboratory substudies will evaluate the gut microbiome, environmental enteric dysfunction, metabolic phenotypes and innate immune function. Qualitative substudies will explore the acceptability and feasibility of the IYCF-plus intervention among participants and community stakeholders, and the effects of migration on food production and consumption.

Ethics and dissemination: This trial is registered at ClinicalTrials.gov (NCT04874688) and was approved by the Medical Research Council of Zimbabwe (MRCZ/A/2679) with the final version 1.4 approved on 20 August 2021, following additional amendments. Dissemination of trial results will be conducted through the Community Engagement Advisory Board in the study district and through national-level platforms.

Trial registration number: NCT04874688.

Keywords: Community child health; Immunology; Nutrition; Nutritional support; QUALITATIVE RESEARCH.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Hypothesised impact of IYCF-plus intervention on barriers to nutrient intake, uptake and utilisation for healthy child growth. IYCF, infant and young child feeding.
See this image and copyright information in PMC

References

    1. Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427–51. 10.1016/S0140-6736(13)60937-X - DOI - PubMed
    1. UNICEF: Levels and trends in child malnutrition, United Nations Children’s fund (UNICEF) . World Health organization, International bank for reconstruction and Development/The world bank levels and trends in child malnutrition: key findings of the 2019 edition of the joint child malnutrition estimates. Geneva: World Health Organization, 2019.
    1. Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health 2014;34:250–65. 10.1179/2046905514Y.0000000158 - DOI - PMC - PubMed
    1. Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 2008;4 Suppl 1:24–85. 10.1111/j.1740-8709.2007.00124.x - DOI - PMC - PubMed
    1. Humphrey JH, Mbuya MNN, Ntozini R, et al. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial. Lancet Glob Health 2019;7:e132–47. 10.1016/S2214-109X(18)30374-7 - DOI - PMC - PubMed

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