Background
Methods
Setting, study area, participants and study design
Outcome measures
Exposure measure
Covariates
Statistical analysis
Ethical considerations
Results
Study population
Total | No stunting | Stunting | P value | |
---|---|---|---|---|
N = 532 N (%) | N = 449 (84.40) | N = 83 (15.60) | ||
Child age mean ± SD (in years) | 7.2 ± 0.4 | 7.2 ± 0.4 | 7.2 ± 0.4 | 0.36 |
Mothers age mean ± SD (in years) | 33.3 ± 6.3 | 33.4 ± 6.4 | 33.1 ± 6.0 | 0.75 |
Underweight (< − 2 SD in weight-for-age) | ≤ 0.0001 | |||
No | 477 (89.8) | 431 (96.0) | 46 (56.1) | |
Yes | 54 (10.2) | 18 (4.0) | 36 (43.9) | |
Thinness (< − 2 SD in BMI-for-age) | 0.96 | |||
No | 512 (96.4) | 433 (96.4) | 79 (96.3) | |
Yes | 19 (3.6) | 16 (3.6) | 3 (3.6) | |
Sex | 0.01 | |||
Girls | 251 (47.2) | 227 (50.6) | 54 (65.1) | |
Boys | 281 (52.8) | 222 (49.4) | 29 (34.9) | |
Child in school | 0.003 | |||
Yes | 265 (49.8) | 236 (52.6) | 29 (34.9) | |
No | 267 (50.2) | 213 (47.4) | 54 (65.1) | |
Child has been hospitalized | 0.57 | |||
No | 402 (77.0) | 340 (76.6) | 62 (79.5) | |
Yes | 120 (23.0) | 104 (23.4) | 16 (20.5) | |
Child has history of cerebral malaria | 0.11 | |||
No | 443 (91.1) | 380 (92.0) | 63 (86.3) | |
Yes | 43 (8.9) | 33 (8.0) | 10 (13.7) | |
Child plays with object at home | 0.77 | |||
No | 265 (52.3) | 222 (52.0) | 43 (53.8) | |
Yes | 242 (47.7) | 205 (48.0) | 37 (46.2) | |
Child was beaten in the last 12 months | 0.06 | |||
No | 483 (95.3) | 410 (96.0) | 73 (91.3) | |
Yes | 24 (4.7) | 17 (4.0) | 7 (8.7) | |
Father employed | 0.79 | |||
Yes | 68 (13.4) | 58 (13.6) | 10 (12.5) | |
No | 439 (86.6) | 369 (86.4) | 70 (87.5) | |
Father educated | 0.19 | |||
Yes | 153 (30.5) | 124 (29.4) | 29 (36.7) | |
No | 348 (69.5) | 298 (70.6) | 50 (63.3) | |
Mother employed | 0.11 | |||
Yes | 26 (5.1) | 19 (4.5) | 7 (8.8) | |
No | 481 (94.9) | 408 (95.5) | 73 (91.2) | |
Mothers depression status | 0.04 | |||
No | 263 (52.9) | 230 (54.9) | 33 (42.3) | |
Yes | 234 (47.1) | 189 (45.1) | 45 (57.7) | |
Polygamy (father has more than 1 wife) | 0.24 | |||
No | 181 (35.7) | 157 (36.8) | 24 (30.0) | |
Yes | 326 (64.3) | 270 (63.2) | 56 (70.0) | |
Electricity in compound | 0.15 | |||
Yes | 392 (77.3) | 335 (78.5) | 57 (71.3) | |
No | 115 (22.7) | 92 (21.5) | 23 (28.7) | |
PROMISE EBF intervention | 0.10 | |||
Control arm | 284 (53.4) | 233 (51.9) | 51 (61.5) | |
Intervention arm | 248 (46.6) | 216 (48.1) | 32 (38.5) |
Tests | Unstandardized raw score | Standardized z-score | |||||
---|---|---|---|---|---|---|---|
Mean ± SD | Median (IQR) | Min | Max | Median (IQR) | Min | Max | |
Memory (Atlantis—KABC-II) | 43.4 ± 19.3 | 43 (28–58) | 12 | 90 | − 0.02 (− 0.8 to 0.8) | − 1.6 | 2.4 |
Visual abilities (Conceptual Thinking —KABC-II) | 5.1 ± 3.4 | 4 (2–8) | 0 | 16 | − 0.3 (− 0.9 to 0.8) | − 1.5 | 3.2 |
Visual abilities (Face Recognition—KABC-II) | 5.0 ± 3.0 | 4 (3–7) | 0 | 14 | − 0.3 (− 0.6 to 0.8) | − 1.6 | 2.9 |
Memory (Number Recall—KABC-II) | 6.0 ± 1.8 | 6 (5–7) | 0 | 10 | 0.05 (− 0.5 to 0.6) | − 3.2 | 2.2 |
Spatial abilities (Triangle—KABC-II) | 6.7 ± 2.8 | 6 (5–8) | 2 | 14 | − 0.2 (− 0.6 to 0.5) | − 1.7 | 2.6 |
Reasoning (Block Counting—KABC-II) | 4.1 ± 3.6 | 3 (1–7) | 0 | 15 | − 0.3 (− 0.8 to 0.8) | − 1.1 | 3.0 |
General cognition (KABC-II) | 91.6 ± 28.8 | 90 (67–113) | 38 | 179 | − 0.04 (− 0.8 to 0.7) | − 1.8 | 3.0 |
Cognitive flexibility (CCT-1) | 35.6 ± 7.2 | 35 (31–40) | 17 | 54 | − 0.08 (− 0.6 to 0.6) | − 2.6 | 2.5 |
Attention (TOVA) | 2.3 ± 0.6 | 2.3 (1.8–2.7) | 0.5 | 4.0 | − 0.01 (− 0.7 to 0.6) | − 2.6 | 2.6 |
Inhibition (TOVA) | 27.3 ± 16.5 | 24 (15–37) | 0 | 69 | − 0.20 (− 0.7 to 0.5) | − 1.6 | 2.5 |
Stunting and neuro-psychological outcomes
Effect size | Unstandardized | Standardized | P value | |
---|---|---|---|---|
Cohen’s d | Coefficient (95% CI) | Coefficient (95% CI) | ||
Memory (Atlantis—KABC-II) | 0.44a | − 8.6 (− 13.1 to − 4.1) | − 0.4 (− 0.6 to − 0.2) | 0.0002 |
Visual abilities (Conceptual Thinking—KABC-II) | 0.29a | − 0.9 (− 1.8 to − 0.2) | − 0.2 (− 0.5 to − 0.05) | 0.01 |
Visual abilities (Face Recognition—KABC-II) | 0.23a | − 0.7 (− 1.4 to − 0.01) | − 0.2 (− 0.5 to − 0.002) | 0.04 |
Memory (Number Recall—KABC-II) | 0.24a | − 0.4 (− 0.9 to − 0.01) | − 0.2 (− 0.5 to − 0.006) | 0.04 |
Spatial abilities (Triangle—KABC-II) | 0.42a | − 1.2 (− 1.8 to − 0.5) | − 0.4 (− 0.6 to − 0.2) | 0.0004 |
Reasoning (Block Counting—KABC-II) | 0.17 | − 0.6 (− 1.5 to 0.2) | − 0.2 (− 0.4 to 0.05) | 0.1 |
General cognition (KABC-II) | 0.48a | − 13.9 (− 20.5 to − 7.2) | − 0.5 (− 0.7 to − 0.2) | ≤ 0.0001 |
Cognitive flexibility (CCT-1) | 0.25a | 1.8 (0.1 to 3.5) | 0.3 (0.01 to 0.5) | 0.03 |
Attention (TOVA) | 0.27a | − 0.2 (− 0.3 to − 0.02) | − 0.3 (− 0.5 to − 0.03) | 0.02 |
Inhibition (TOVA) | 0.30a | 5.0 (1.0 to 8.9) | 0.3 (0.06 to 0.5) | 0.01 |
Unstandardized | Standardized | P value | |
---|---|---|---|
Coefficienta (95% CI) | Coefficienta (95% CI) | ||
Memory (Atlantis—KABC-II) | |||
No stunting | |||
Stunting | − 7.9 (− 12.3 to − 3.4) | − 0.4 (− 0.6 to − 0.2) | 0.001 |
Visual abilities (Conceptual Thinking—KABC-II) | |||
No stunting | |||
Stunting | − 1.1 (− 1.9 to − 0.3) | − 0.3 (− 0.6 to − 0.07) | 0.01 |
Visual abilities (Face Recognition—KABC-II) | |||
No stunting | |||
Stunting | − 0.7 (− 1.4 to 0.02) | − 0.2 (− 0.5 to 0.01) | 0.06 |
Memory (Number Recall- KABC-II) | |||
No stunting | |||
Stunting | − 0.5 (− 1.0 to − 0.07) | − 0.3 (− 0.5 to − 0.04) | 0.02 |
Spatial abilities (Triangle—KABC-II) | |||
No stunting | |||
Stunting | − 1.1 (− 1.7 to − 0.5) | − 0.4 (− 0.6 to − 0.2) | 0.001 |
Reasoning (Block Counting—KABC-II) | |||
No stunting | |||
Stunting | − 0.7 (− 1.6 to 0.2) | − 0.2 (− 0.4 to 0.04) | 0.11 |
General cognition (KABC-II) | |||
No stunting | |||
Stunting | − 13.2 (− 19.7 to − 6.8) | − 0.5 (− 0.6 to − 0.2) | ≤ 0.0001 |
Cognitive flexibility (CCT-1) | |||
No stunting | |||
Stunting | 1.8 (0.02 to 3.5) | 0.2 (0.003 to 0.5) | 0.04 |
Attention (TOVA) | |||
No stunting | |||
Stunting | − 0.2 (− 0.3 to − 0.02) | − 0.2 (− 0.5 to − 0.03) | 0.02 |
Inhibition (TOVA) | |||
No stunting | |||
Stunting | 4.6 (0.5 to 8.8) | 0.3 (0.03 to 0.5) | 0.02 |