Grandi Byen-supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial.

BACKGROUND: Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development. METHODS: We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions. DISCUSSION: This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally. TRIAL REGISTRATION: NCT04785352 . Registered March 5, 2021 at https://clinicaltrials.gov/.

Predictors of anemia among haitian children aged 6 to 59 months and women of childbearing age and their implications for programming.

BACKGROUND: The Haitian National Nutrition Policy prioritizes prevention and treatment of anemia among mothers and young children, but there are few available data to support planning for scale-up of anemia interventions. OBJECTIVE: To describe the prevalence and predictors of anemia among Haitian women (15 to 49 years) and children (6 to 59 months) and to draw implications for national nutrition programming. METHODS: Descriptive and univariate analyses and multivariate logistic regression models were performed using data from the nationally representative Haitian Demographic Health Survey 2005/06. RESULTS: The prevalence of mild (hemoglobin 11.0 to 11.9 g/dL), moderate (hemoglobin 8.0 to 10.9 g/dL), and severe (hemoglobin < 8.0 g/dL) anemia was 19.2%, 21.7%, and 4.4%, respectively, among women aged 15 to 49 years and 22.9%, 33.9%. and 2.2% among children aged 6 to 59 months. Unexpectedly anemia was more prevalent in urban women (54.4 %) and children (65.1%) than in rural women (43.1%, p < .001) and children (55.7%, p = .004). In multivariate regression models, factors associated with anemia among urban women (birth spacing, p = .027; overweight BMI, p < .001; education level, p = .022) were different from those in rural women (wealth quintile, p < .05; employment, p = .003). Anemia in urban and rural children aged 6 to 59 months increased with child age (p < .05) and maternal anemia status (p = .004; p < .001). Female sex (p = .007) and maternal overweight (p = .009) were associated with reduced risk of anemia in rural children only. CONCLUSIONS: Anemia among Haitian young children and women of childbearing age is a severe public health problem. The findings suggest the need for context-specific rural and urban strategies, reinforcement of anemia prevention in health services reaching women of childbearing age, and targeted interventions for young children.

Précis of nutrition of children and women in Haiti: analyses of data from 1995 to 2012.

Between 1995 and 2012, many surveys including child and maternal nutrition indicators were conducted in Haiti. While many questions emerged from the results of those surveys, they have remained unanswered, in particular as they pertain to the determinants of poor children's and women's nutrition in Haiti. The purpose of this paper is to fill that gap and provide policymakers, program managers, and readers interested in nutrition issues in Haiti with information on (1) the trends and determinants of infant and young child feeding and food practices; (2) micronutrient deficiencies among children and women; (3) the status of severe acute malnutrition in children; (4) associations among women's empowerment, access to health care, water, and sanitation and child nutrition; (5) the current community-based early child care and nutrition initiatives; and (6) the status of nutrition governance in the country. By looking at many sources of data, including previously published and new data, we provide insight into major predictors of child malnutrition and associations among child feeding practices, maternal nutrition, and child growth outcomes. We also show that important progress has been made recently in the governance of nutrition programs and in child and maternal nutrition indicators, a result of effective evidence-based advocacy, partnerships, and design, implementation, and scale-up of nutrition-specific and sensitive interventions.

Child malnutrition in Haiti: progress despite disasters.

Undernutrition, a chief child killer in developing countries, has been a major public health problem in Haiti. Following the 2010 disasters (earthquake and cholera) and the intensive relief efforts to address them, we sought to determine the trends of child undernutrition in Haiti using data from the 2005-06 Haiti Demographic and Health Survey (HDHS) and from a Standardized Monitoring and Assessment of Relief and Transitions (SMART) survey in 2012. Growth data analyses included 2,463 (HDHS) and 4,727 (SMART) children ages 0-59 months. We calculated the prevalence of stunting, wasting, and underweight for each survey using World Health Organization 2006 growth standards. To account for sampling design, probability weights were applied to all analyses. Statistical significance was determined by non-overlapping confidence intervals around estimates. Stunting prevalence declined from 28.5% (95% confidence interval [CI] = 25.9, 31.3) in 2005-06 to 22.2% (95% CI = 20.2, 24.3) in 2012; wasting, from 10.1% (95% CI = 8.2, 12.7) to 4.3% (95% CI = 3.6, 5.2); and underweight, from 17.7 % (95% CI = 15.6, 20.1) to 10.5% (95% CI = 9.3, 11.9). Additionally, stunting declined more in rural areas, from 33.6% (95% CI = 30.1, 37.2) in 2005-06 to 25% (95% CI = 23.4, 26.7) in 2012, than in urban areas, from 18.6% (95% CI = 15.3, 22.5) in 2005-06 to 18.4% (95% CI = 16.7, 20.1) in 2012, for reasons that remain unknown. Results of the 2012 HDHS confirmed the observed trends. Thus, undernutrition among Haitian children under 5 declined significantly between 2005-06 and 2012. Our results should be interpreted in view of investments and changes that occurred in different sectors (within and outside health and nutrition) before and after the earthquake.