Mild and Moderate Malnourished Children Clinical Trial
The Bangladesh Integrated Nutrition Project (BINP) of the Government of Bangladesh has started showing reduction in malnutrition of women and children under two years of age in last 3 years of it’s activities. That was a demonstration study to test the efficacy of the approach on a relatively small number of children with intensive intervention. A study will be therefore conducted in 4 division of BINP thanas of Bangladesh over an 18-month period. Moderately malnourished children will be in management intervention and mildly malnourished and well-nourished infants will be in preventive intervention group. For management intervention, a total of 750 moderately malnourished will be randomized to receive either intensive nutrition education or less intensive education. For preventive purpose, 380 mildly malnourished children of 6 months to 2 years of age and 240 well nourished infants of 6 to 9 months of age will receive either less intensive education or no education. Infants between 6 to 9 month ages will be brought under less INE to ensure their complementary feeding practice. Care givers of one group of mildly malnourished children and one group of 6-9 month old infants will not receive any education to serve as controls. Focus group discussion will be held before the educational intervention to identify the perception of the mother, her husband and female decision maker of her family on child nutrition, caring practice and common practice of health care. BCC materials will be developed after FGD and that will be used during nutrition education. Mothers of the first intervention group will receive intensive nutrition education for child feeding twice weekly for first three months, which will be then reinforced once in a week for the last three months of intervention. The less intensive intervention group will receive nutrition education twice a week for the first month then once a week for two months and then twice monthly for the last three months of intervention. INE will be given for a total of 6 months. An observation will be done to identify for sustainability effect for an additional period of 6 months. Their weight and length gain will be recorded. It is expected that the results of the study will help define the effectiveness of our nutrition education package to prevent and reduce moderate malnutrition existing in large proportion of children in setting with different geographical, and cultural and feeding practices.
Bangladesh has the highest proportion of malnourished children in the world. The infant and
child mortality are also among the highest in south Asia. In Bangladesh, `. The Government
of Bangladesh has been trying different ways for reducing childhood malnutrition. Such
programs include the Vulnerable Group Development (VGD) Project, vitamin A distribution
project, iodine deficiency disorder control program, iron supplementation program and
improving food availability for the underprivileged sections of the society. Despite these,
not enough improvement has been observed in the field of nutrition. In review of the past
fifty-year’s information of dietary intake and growth, it has been observed that food intake
has substantially decreased and growth faltering in children has worsened (Roy et al 1988).
Materal malnutrition is evidenced by low weight, short stature and anemia in pregnant and
lactating women. Micronutrient deficiencies are evidenced by prevalence of xerophthalmia,
iron deficiency anemia and iodine deficiency disorders. The effects of childhood under
nutrition, begin with a low birth weight (estimated to occur among 35-50% of births in
Bangladesh) (Hasan et al 1995) and continue into adulthood.
The prevalence of PEM among children is very high, and has remained almost the same for the
last decade. Thirty percent of all children under six years of age are severely stunted and
another 31.2% are moderately stunted (BBS 1995). As many as 68.3% of the total children are
under -weight and 16.7% are wasted, the highest rates are in Asia (BBS 1995). Given the
greatly disadvantaged start by the way of a low birth-weight followed by inadequate
breast-feeding by their undernourished mothers, average Bangladeshi infants are already
below the lower end of the range of anthropometric values found among western babies during
the first three to six months. The late and insufficient introduction of complementary
feeding further retards the infant's growth; usually the child do not pick up its pace of
growth before two years of age. By then, it is too late to reverse the early growth lag,
which persists throughout the life, and similarly some of the damages done to mental
development are irreparable. The weight for age curve of Bangladeshi children continues to
lie below the third percentile of the NCHS Standard, though it runs roughly parallel to the
standard from around the second year of life onward; the older children cope better with the
adverse milieu of food-insecure and unhealthy household, while being unable to regain lost
ground.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention