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Effectiveness of wheat soya blend supplementation during pregnancy and lactation on pregnancy outcomes and nutritional status of their infants at 6 months of age in Thatta and Sujawal districts of Sindh, Pakistan: a cluster randomized-controlled trial

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Abstract

Purpose

We aimed to assess the effectiveness of wheat soya blend plus (WSBP) provided during pregnancy and lactation on weight gain during pregnancy, reduction of low birthweight (LBW), and improvement in nutritional status in infants at 6 months of age in Thatta and Sujawal districts of Sindh, Pakistan.

Methods

A cluster randomized-controlled trial was conducted in Thatta and Sujawal districts in Pakistan from August 2014 to December 2016. A total of 2030 pregnant women were enrolled in the study. These women and their infants were followed during pregnancy and first 6 months of life. Pregnant women received a monthly ration of 5 kg (i.e., 165 g/day) of WSB + during pregnancy and the first 6 months of their lactation period.

Results

There was no difference in weight gain during pregnancy between the intervention and control groups (n = 496, 326.7 g/week 95% CI 315.2–338.1 vs. (n = 507, 306.9 g/week, 95% CI 279.9–333.9 P = 0.192), after adjustment with different factors. The reduction in the prevalence of LBW was not different between intervention and control groups (n = 325, 34.0%, 95% CI 31.7–36.4, vs. (n = 127, 34.3%, 95% CI 27.2–41.5, P = 0.932). Significant reductions in risk of stunting (n = 1319 RR 0.85, 95% CI 0.73–0.99, P = 0.041), wasting (n = 1330 RR 0.77, 95% CI 0.65–0.91, P = 0.003), and underweight (n = 1295 RR 0.77, 95% CI 0.69–0.87, P < 0.001) were observed in infants at 6 months of age in the intervention as compared to the control group. However, no difference was noted on reduction in the risk of stunting among infants at 6 months of age in the intervention and control group (n = 1318 RR 0.91, 95% CI 0.78–1.07, P = 0.253) after adjustment. A significant reduction in anemia was noted (n = 1328 RR 0.94, 95% CI 0.91–0.98, P = 0.002) in infants at 6 months of age in the intervention as compared to the control group in adjusted analysis.

Conclusions

Provision of WSB + during pregnancy and the first 6 months of lactation is effective in reducing the risk of under nutrition and anemia in infants at 6 months of age. This study can potentially guide the government and donor agencies in investing in nutritional programmes, especially for pregnant and lactating women living in vulnerable settings.

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Fig. 1

Abbreviations

AKU:

Aga Khan University

LHW:

Lady health worker

LNS:

Lipid-based nutrient supplements

MICS:

Multiple indicator cluster survey

MNP:

Micro-nutrient powders

PLW:

Pregnant and lactating women

UC:

Union council

WSBP:

Wheat soya blend plus

References

  1. Abu-Saad K, Fraser D (2010) Maternal nutrition and birth outcomes. Epidemiol Rev 32:5–25

    Article  Google Scholar 

  2. Couperus JW, Nelson CA (2006) Early brain development and plasticity. In: McCartney K, Phillips D (eds) The Blackwell handbook of early childhood development. Blackwell, MA, USA, pp 85–105

    Chapter  Google Scholar 

  3. Khan Y, Bhutta ZA (2010) Nutritional deficiencies in the developing world: current status and opportunities for intervention. Podiatry Clin N Am 57:1409–1441

    Article  Google Scholar 

  4. Black RE, Victora CG, Walker SP et al (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382:427–451

    Article  Google Scholar 

  5. Bhutta ZA, Ahmed T, Black RE et al (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet 371:417–440

    Article  Google Scholar 

  6. Devakumar D, Fall CH, Sachdev HS, Margetts BM, Osmond C, Wells JC, Costello A, Osrin D (2016) Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis. BMC Med 14:90

    Article  Google Scholar 

  7. Dewey KG, Begum K (2011) Long-term consequences of stunting in early life. Matern Child Nutr 7:5–18

    Article  Google Scholar 

  8. Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R (2010) Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics 125:e473–e480

    Article  Google Scholar 

  9. Adair LS, Fall CH, Osmond C et al (2013) Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet 382:525–534

    Article  Google Scholar 

  10. Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, Fawzi W, Caulfield LE, Danaei G (2013) Nutrition impact model study associations of suboptimal growth with all-cause and cause-specific mortality in children under 5 years: a pooled analysis of ten prospective studies. PLoS ONE 8:e646–e636

    Article  Google Scholar 

  11. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, Prentice A (2013) Critical windows for nutritional interventions against stunting. Am J Clin Nutr 97:911–918

    Article  CAS  Google Scholar 

  12. Leroy JL, Ruel M, Habicht JP, Frongillo EA (2014) Linear growth deficit continues to accumulate beyond the first 1000 days in low- and middle-income countries: global evidence from 51 national surveys. J Nutr 144:1460–1466

    Article  CAS  Google Scholar 

  13. Lundeen EA, Stein AD, Adair LS et al (2014) Height-for-age Z scores increase despite increasing height deficits among children in five developing countries. Am J Clin Nutr 100:821–825

    Article  CAS  Google Scholar 

  14. The International Bank For Reconstruction and Development (2006) repositioning nutrition as central to development a strategy for large-scale action. https://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf. Accessed 26 March 2019.

  15. Kramer MS, Kakuma R (2003) Energy and protein intake in pregnancy. Cochrane Database Syst Rev 4:32

    Google Scholar 

  16. Ceesay SM, Prentice AM, Cole TJ, Foord F, Poskitt EME, Weaver LT, Whitehead RG (1997) Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomized controlled trial. BMJ 315:786–790

    Article  CAS  Google Scholar 

  17. Imdad A, Bhutta ZA (2011) Effect of balanced protein energy supplementation during pregnancy on birth outcomes. BMC Public Health 11:17

    Article  Google Scholar 

  18. World Health Organization (2012) WHO Guideline: daily iron and folic acid supplementation in pregnant women geneva. World Health Organization, Geneva, p 27

  19. Fall CHD, Fisher DJ, Osmond C, Margetts BM (2009) Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation. Food Nutr Bull 30:S533–S546

    Article  Google Scholar 

  20. Margetts BM, Fall CHD, Ronsmans C, Allen LH, Fisher DJ (2009) Maternal micronutrient supplementation study group multiple micronutrient supplementation during pregnancy in low-income countries: review of methods and characteristics of studies included in the meta-analyses. Food Nutr Bull 30(7):S526

    Google Scholar 

  21. Haider BA, Yakoob MY, Bhutta ZA (2011) Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Public Health 11:S19

    Article  Google Scholar 

  22. Stevens B, Buettner P, Watt K, Clough A, Brimblecombe J, Judd J (2015) The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis. Matern Child Nutr 11:415–432

    Article  Google Scholar 

  23. Ota E, Hori H, Mori R, Tobe-Gai R, Farrar D (2015) Antenatal dietary education and supplementation to increase energy and protein intake. Cochrane Database Syst Rev 6:32

    Google Scholar 

  24. Janmohamed A, Karakochuk CD, Boungnasiri S, Chapman GE, Janssen PA, Brant R, Green TJ, McLean J (2016) Prenatal supplementation with corn soya blend plus reduces the risk of maternal anemia in late gestation and lowers the rate of preterm birth but does not significantly improve maternal weight gain and birth anthropometric measurements in rural cambodian women: a randomized trial. Am J Clin Nutr 103:559–566

    Article  CAS  Google Scholar 

  25. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf;jsessionid=C01C1A267A8455401C2BFA47E548FF5B?sequence=1. Accessed 26 Mar 2019

  26. Bhutta ZA, Das JK, Rizvi A et al (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382:9890

    Google Scholar 

  27. Imdad A, Yakoob MY, Bhutta ZA (2011) Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries. BMC Public Health 11(3):S25

    Article  Google Scholar 

  28. Lassi ZS, Das JK, Zahid G, Imdad A, Bhutta ZA (2013) Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review. BMC Public Health 13(3):S13

    Article  Google Scholar 

  29. Soofi S, Nawaz G, Garzon C (2019) Effect of lipid-based nutrient supplement-medium quantity on reduction of stunting in children 6–23 months of age in Sindh, Pakistan: a cluster randomized controlled trial current developments in nutrition. Nutritions 3:5–25

    Google Scholar 

  30. Impact of nutrition supplementation programme within the primary healthcare system to prevent stunting among children under 5 years in Thatta and Sujawal districts, Sindh, Pakistan: cross-sectional surveys. Unpublished manuscript, Aga Khan University, Karachi, Pakistan.

  31. Sindh Coastal and inland community development project (2005) Asian Development Bank, Project No. 37188, Tech Ass Consultant Rep Vol-II. https://www.adb.org/projects/37188-013/main

  32. Khan SB, Ahmad M, Sadaf M, Kashif M, Hamid R (2009) Crops Area And Production (By Districts) (1981-82 TO 2008-09)

  33. Leroy JL, Olney D, Ruel M (2018) Tubaramure, a food-assisted integrated health and nutrition program, reduces child stunting in Burundi: a cluster-randomized controlled intervention trial. J Nutr 148:445–452

    Article  Google Scholar 

  34. Olney D, Leroy JL, Bliznashka L, Ruel M (2018) PROCOMIDA, a food-assisted maternal and child health and nutrition program, reduces child stunting in Guatemala: a cluster-randomized controlled intervention trial. J Nutr 148:1493–1505

    Article  Google Scholar 

  35. Mridha MK, Matias SL, Chaparro CM et al (2016) Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh. Am J Clin Nutr 103:236–249

    Article  CAS  Google Scholar 

  36. Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Peerson JM, Arimond M, Ashorn U, Zeilani M, Vosti S, Dewey KG (2016) Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 month postpartum and to their infants from 6 month of age increase the mean attained length of 18-month-old children in semi-urban Ghana: a randomized controlled trial. Am J Clin Nutr 104:797–808

    Article  CAS  Google Scholar 

  37. Gresham E, Byles JE, Bisquera A, Hure AJ (2014) Effects of dietary interventions on neonatal and infant outcomes: a systematic review and meta-analysis. Am J Clin Nutr 100:1298–1321

    Article  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank all the study participants for the participation. We also thank data collection teams, data management unit, grants, and administrative staff for their hard work. The authors’ responsibilities were as follows: SS was PI of the study and designed the study design, and reviewed and interpreted the data; ZAB reviewed study design and final draft of the manuscript. GNK: supervised data collection activities and wrote the first draft of manuscript; MS and AR: contributed in data analysis; SA, SK, CG, SdeP, and MJ critically reviewed the manuscript. All authors reviewed and approved the final manuscript.

Funding

World Food Programme, Islamabad, Pakistan.

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Correspondence to Sajid Bashir Soofi.

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Khan, G.N., Ariff, S., Kureishy, S. et al. Effectiveness of wheat soya blend supplementation during pregnancy and lactation on pregnancy outcomes and nutritional status of their infants at 6 months of age in Thatta and Sujawal districts of Sindh, Pakistan: a cluster randomized-controlled trial. Eur J Nutr 60, 781–789 (2021). https://doi.org/10.1007/s00394-020-02276-3

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