RESUMO
BACKGROUND: Stunting affects child survival and is a key indicator of child well-being. Therefore, reducing stunting is a global goal. Improving infant and young child feeding (IYCF) practices is a recommended approach to reduce the risk of mortality and ameliorate nutritional status. Behavioural change interventions have the potential to improve IYCF practices. METHODS: We evaluated the effectiveness of an innovative behavioural change strategy on caregiver's knowledge, IYCF practices and nutritional status of children from low-income households in El Alto, Bolivia. Home visits used culturally adapted participatory play strategies to promote recommended IYCF practices. A total of 2014 households with children younger than 12 months at baseline were randomly assigned to treatment and control groups. FINDINGS: Caregiver knowledge and IYCF practices improved by 0.2 SD, as did food expenditures on recommended foods and dietary diversity. No significant effects were detected on anthropometric indicators or anaemia. Treatment compliance was 88% of households at enrolment and 66% at completion. INTERPRETATION: Participatory play-based behavioural change strategies are a promising delivery model to improve recommended IYCF practices. After 30 months of intervention, we found sustained positive effects on caregiver's knowledge and IYCF practices but no effect on nutritional status. Despite the lack of effect on linear growth and anaemia, our results highlight the relevance of implementing interventions that improve IYCF practices due to their importance for early development and prevention of obesity. Other contextual variables, apart from diet, that could be limiting children's growth potential in this population need to be identified to design holistic approaches that improve child well-being and human capital.
RESUMO
After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA, positive effects on physical growth, prevalence of anemia, and several vitamin deficiencies were observed. There was no effect on iron status, which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA. The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food. Children (n = 54) aged 2-4 y were randomly assigned to receive 44 g of the weaning food fortified with ferrous sulfate, ferrous fumarate, or reduced iron + Na(2)EDTA. Iron absorption was measured using an established double-tracer isotopic methodology. Iron absorption from ferrous sulfate (7.9 +/- 9.8%) was greater than from either ferrous fumarate (2.43 +/- 2.3%) or reduced iron + Na(2)EDTA (1.4 +/- 1.3%) (P < 0.01). The absorption of log-(58)Fe sulfate given with the iron source correlated with serum ferritin (s-ferritin) concentration (n = 13, r = 0.63, P = 0.01) and log-(57)Fe absorption (reference dose) (n = 14, r = -0.52, P = 0.02). Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of (57)Fe. The recommended daily portion of the fortified complementary food provides an average of 0.256, 0.096, 0.046 mmol (1.44, 0.54, and 0.26 mg) of absorbed iron, if fortified with sulfate, fumarate and reduced iron + Na(2)EDTA, respectively. Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + Na(2)EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2-3 y of age.