Nutrition Supplement Distribution Analysis
"There was no benefit to the
integration of water, sanitation,
and handwashing with nutrition.
Adherence was high in all
groups and diarrhoea
prevalence was reduced in all
intervention groups except
water treatment.
Combined water, sanitation, and
handwashing interventions
provided no additive benefit
over single interventions."
Effects of water quality, sanitation, handwashing, and
nutritional interventions on diarrhoea and child growth in
rural Bangladesh: a cluster randomised controlled trial
Stephen Pady Mahbubenej American Sonic ArtStream
Farge Hain jade Benjamin-Chong Erotiin Abu Mt Nesel Serie Ste Albuddetin feil A Name Karjamet
Arrynal Abden, Thomas Desen Ketty Dry Lord Cha
My
Summary
Articles
oa
Background Diarrhoea and growth faltering in early childhood are associated with subsequent adverse outcomes. We
aimed to assess whether water quality, sanitation, and landwashing interventions alone or combined with mutrition eve
interventions reduced diarrhoea or growth faltering
Methods The WASH Benefits Bangladesh cluster-randomised trial enrolled pregnant women from villages in
rural Bangladesh and evaluated outcomes at 1-year and 2-years follow-up. Pregnant women in geographically
adjacent clusters were block-randomised to one of seven clusters chlorinated drinking water (water opgraded som
sanitation (sanitation): promotion of handwashing with soap thandwashing: combined water, sanitation, and s
handwashing counseling en appropriate child mitrition plus lipid-based nutrient supplements (nutrition);
combined water, sanitation, handwashing, and mutrition; and control (data collection only). Primary outcomes
were caregiver-reported diarrhoea in the past 7 days among children who were in utero or younger than 3 years a
enrolment and length-decage Z score among children born to enrolled pregnant women. Masking was not possible
for data collection, but analyses were masked. Analysis was by intention to treat. This trial is registered at
ClinicalTrials.gov, number NCC01590095
School of
of
Findings Between May 31, 2012, and July 7, 2013, 5551 pregnant women in 720 clusters were randomly allocated to
one of seven groups. 1382 women were assigned to the control group: 699 to water; 696 to sanitation 685 to SA
handwashing: 702 to water, sanitation, and handwashing 699 to nutrition: and 656 to water, sanitation,
handwashing, and nutrition. 331 (6%) women were lost to follow-up. Data on diarrhoea at year 1 or year 2 A
(combined) were available for 14425 children (7331 in year 1, 7094 in year 2 and data on length-forage score in
year 2 were available for 4554 children (92% of living children were measured at year 2. All interventions had high c
adherence. Compared with a prevalence of 5.7% (200 of 3517 child weeks) in the control group. 7-day diarrhoea
prevalence was lower among index children and children under 3 years at enrolment who received sanitation
1613-5%) of 176 prevalence ratio 0.61, 95% CI 0-46-0-81), handwashing (6213-5% of 1795; 0.60, 0-45-0.80)
combined water, sanitation, and handwashing (7413-9%) of 1902, 06, 0-53-0-90), nutrition (62 [3-5% of 1766;
064,0 49-0-85), and combined water sanitation, Sandwashing, and nutrition (6613-5% of 1861 0.62, 0.47-0.53
diarrhoea prevalence was not significantly lower in children receiving water treatment (90 14-9%) of 1824: 0-89, A
0-70-1-13). Compared with control (mean length-far-age Z score -1-79), children were taller by year 2 in the
nutrition group (mean difference 0-25 195% CI 0-15-0-363 and in the combined water, sanitation, handwashing, pati
and matrition group (0-13 0 92-9-24 The individual water, sanitation, and handwashing groups, and combined
water, sanitation, and handwashing group had no effect on linear growth.
Interpretation Natrient supplementation and counselling modestly improved linear growth, but there was no
benefit so the integration of water, sanitation, and handwashing with nutrition. Adhercoce was high in all group
and diarrhoea prevalence was reduced in all intervention groups except water treatment. Combined water,
sanitation, and handwashing interventions provided so additive benefit over single interventions
Funding Bill & Melinda Gates Foundation.
Copyright © The Author). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Introduction
Over 200 million children bon in low-income countries
are at risk of not reaching their development potential
Poor linear growth in early childhood is a marker
for donc deprivation that is associated with
increased mortality, impaired cognitive development,
and reduced adult income Nutrition-specific intes
ventions have been shown to improve child growth
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