Effect of a Center-Based Early Childhood Care and Education Program on Child Nutritional Status: A Secondary Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial in Rural Sindh, Pakistan.
J Nutr
; 154(2): 755-764, 2024 Feb.
Article
en En
| MEDLINE
| ID: mdl-38072156
ABSTRACT
BACKGROUND:
High-quality early childhood care and education (ECCE) programs can positively impact children's development. However, as an unintended consequence, ECCE attendance may also affect children's nutritional status.OBJECTIVE:
We evaluated the effect of a center-based ECCE intervention on child nutritional outcomes in rural Pakistan.METHODS:
This study utilized data from a stepped-wedge cluster randomized controlled trial of a center-based ECCE program that trained female youth to run high-quality preschools for children aged 3.5-5.5 y (Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) program) in rural Sindh, Pakistan. The program did not include any school meals. A total of 99 village clusters were randomized to receive the LEAPS intervention in 3 steps, and repeated cross-sectional surveys were conducted to assess the impact on children (age 4.5-5.5 y) at 4- time points. ITT analyses with multilevel mixed-effect models were used to estimate the effect of the intervention on child anthropometric outcomes.RESULTS:
The analysis included 3858 children with anthropometric data from 4 cross-sectional survey rounds. The LEAPS intervention was found to have a positive effect on child height-for-age z score (mean difference 0.13 z-scores; 95% confidence interval [CI] 0.02, 0.24). However, there was a negative effect on weight-based anthropometric indicators, -0.29 weight-for-height z score (WHZ) (95% CI -0.42, -0.15), -0.13 BMI z score (BMIZ) (95% CI -0.23, -0.03), and -0.16 mid-upper arm circumference-for-age z score MUACZ (95% CI -0.25, -0.05). An exploratory analysis suggested that the magnitude of the negative effect of LEAPS on WHZ, BMIZ, and weight-for-age z score (WAZ) was greater in the survey round during the COVID-19 lockdown.DISCUSSION:
The LEAPS intervention positively affected child linear growth but had negative effects on multiple weight-based anthropometric measures. ECCE programs in low- and middle-income country settings should evaluate the integration of nutrition-specific interventions (eg school lunch, counseling on healthy diets) and infection control strategies to promote children's healthy growth and development. CLINICAL TRIAL REGISTRY clinicaltrials.gov, NCT03764436, https//clinicaltrials.gov/ct2/show/NCT03764436.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fenómenos Fisiológicos Nutricionales Infantiles
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Estado Nutricional
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
País/Región como asunto:
Asia
Idioma:
En
Revista:
J Nutr
Año:
2024
Tipo del documento:
Article