Impact of an Integrated Agricultural, Nutrition, and Water, Sanitation and Hygiene Intervention during the First 1000 Days on Child Growth and Micronutrient Status in Western Kenya: A Cluster-Randomized Controlled Trial.

BACKGROUND: Agricultural programs alone have shown limited impact on nutritional status. OBJECTIVES: We hypothesized that linear growth would improve by adding nutrition and water, sanitation and hygiene components to an existing agriculture program, targeting pregnant females and their offspring over the 1000-d window. METHODS: We conducted a cluster-randomized controlled trial in rural Kenya. Females <20 wk pregnant were randomly assigned to an existing agricultural intervention without (control) or with additional interventions (intervention), provided from enrolment until their child reached 24 mo. Additional interventions included daily small-quantity lipid-based nutrient supplements (SQ-LNS) to females during pregnancy until 6 mo postpartum; micronutrient powders (MNP) and eggs to children; and soap, chlorine solution, and monthly behavior change trainings. The main outcome was length-for-age z-score (LAZ) at 24 mo. Safety was assessed through active morbidity and passive adverse event monitoring. We used mixed-effects generalized linear models for analysis. RESULTS: Between June and December 2018, 1199 pregnant females from 164 clusters were enrolled (628 intervention and 571 control). Data on LAZ were available for 976 (81.4%) children at 24 mo. Adherence was >75% for SQ-LNS, MNP, eggs, and chlorine, and ∼50% for soap. At 24 mo, mean LAZ [95% confidence interval (CI)] was higher in the intervention group [-0.91 (-1.00, -0.82)] than in the control group [-1.15 (-1.25, -1.06)], with an adjusted effect size (95% CI) of 0.24 (0.11, 0.37), and stunting prevalence was lower [12% compared with 19%, adjusted relative risk: 0.69 (0.50, 0.96)]. LAZ declined less from birth to 24 mo in the intervention group [effect: 0.18 (0.06, 0.31)]. Intervention children showed better iron and vitamin A status at 6 and 24 mo and a lower prevalence of diarrhea at 6 mo; stunting at 6 mo and diarrhea at 24 mo did not differ between groups. CONCLUSIONS: An integrated intervention during pregnancy and early childhood improved linear growth and micronutrient status and reduced diarrheal disease. This trial was registered at clinicaltrials.gov as NCT03558464 (https://clinicaltrials.gov/study/NCT03558464?locStr=Kenya&country=KE&cond=NCT03558464&aggFilters=status:com&rank=1).