Malnutrition is estimated to cause half of all preventable deaths in infants worldwide. Some of the most common nutritional problems in developing countries are stunted growth and iron-deficiency anaemia.
Mary Penny (Instituto de Investigacion Nutricional, Lima, Peru) and colleagues tested whether a nutritional education intervention delivered through government primary health centres could improve the growth of the children in a shanty town in Trujillo, Peru. 12 government health facilities were recruited onto the study. The researchers randomly selected 6 centres and introduced several measures to ensure that all carers of young children seen in the centres received age-appropriate, practical, easily understood, nutrition advice every time they visited the centre. The centres also introduced complementary feeding demonstrations, group sessions on growth monitoring, and a system of accreditation for centres. 380 mothers were enrolled into the trial from August 1999 to February 2000--half from the catchment area of the intervention centres and half from the centres that did not have the intervention programme. Field workers visited the families as soon as possible after birth and at regular intervals up to the 18 months of age to assess growth, feeding practices, and dietary intake of energy, minerals and vitamins.
Caregivers in intervention areas reported receiving nutritional advice from health services more often than caregivers in control health facilities. At 6 months more children in the intervention group were fed nutrient-dense thick foods at lunch (a recommended feeding practice) and met dietary requirements for energy, iron, zinc than controls. The investigators found that the rate of stunting fell by more than two thirds in children of families in the intervention group.
Dr Penny states: "Malnutrition is a major cause of child morbidity and mortality, and effective interventions are urgently needed to prevent growth faltering in young children. Our educational intervention prevented stunting, a form of chronic malnutrition that occurs in more than 15% of infants in this population. Research is needed to determine the sustainability of the intervention in Trujillo, and the generalisability of the intervention strategy to similar settings in Peru and elsewhere."
In an accompanying comment Kathryn Dewey (University of California, Davis, USA) states: "The positive results of the intervention give hope to policymakers that this strategy will be effective elsewhere. However, a prerequisite is that health services have wide coverage, especially for the most disadvantaged groups. The longterm sustainability of comprehensive efforts to improve the nutrition of infants (aged 0–12 months old) and young children (aged 1–5 years old) must still be demonstrated, but there is now clear evidence that appropriately designed interventions can work."
Contact: Dr Mary Penny MBChB, Instituto de Investigacion Nutricional (IIN)Avenida La Molina 1885, La Molina, Lima 12, Peru.
T) 51-1-349-6023
mpenny@iin.sld.pe
Comment: Dr Kathryn G Dewey, Department of Nutrition, University of California, 1 Shields Avenue, Davis, CA 95615-8669, USA.
T) 1-530-752-0851
kgdewey@ucdavis.edu
Journal
The Lancet