Background
Methods
Study design and population
Measures
Anthropometric measurements
Mental health measure
Other covariates
Nutritional indices
Sample size estimation
Data Management
Ethical considerations
Data Analysis
Results
Cohort characteristics
Characteristics
|
6 month follow-up
|
12 month follow-up
| |||
---|---|---|---|---|---|
Baseline sample n(%) or Mean(SD) | Number | Percent or mean(SD) | Number | Percent or mean(SD) | |
Religion | |||||
Muslim | 824(77.6) | 673 | 77.2 | 722 | 78.0 |
Orthodox Christian | 161(15.1) | 133 | 15.3 | 139 | 15.0 |
Protestant | 66(6.2) | 56 | 6.4 | 55 | 5.9 |
Catholic | 12(1.1) | 10 | 1.2 | 10 | 1.1 |
Ethnicity | |||||
Meskan | 485(44.5) | 404 | 46.3 | 436 | 47.1 |
Mareko | 147(13.8) | 119 | 13.7 | 123 | 13.3 |
Silti | 257(24.1) | 199 | 22.8 | 218 | 23.5 |
Sodo | 85(8.0) | 69 | 7.9 | 68 | 7.3 |
Others | 91(9.6) | 81 | 9.3 | 81 | 8.8 |
Currently married | 1055(99.1) | 824 | 99.1 | 867 | 99.0 |
Occupation | |||||
Housewife or farming | 933(87.9) | 758 | 87.1 | 805 | 87.1 |
Self or paid employee | 129(12.2) | 112 | 12.9 | 119 | 12.9 |
Maternal age in years (n = 1065) | 26.9(6.4) | 872 | 26.9(6.2) | 926 | 26.9(6.2) |
Educational status of mother | |||||
Formal education | 219(20.6) | 173 | 19.8 | 185 | 20.0 |
No formal education | 846(79.4) | 699 | 80.2 | 741 | 80.0 |
Age of husband in years (n = 1050) | 36.2(9.2) | 858 | 36.0(8.3) | 911 | 36.1(8.9) |
Educational status of husband | |||||
Able to read | 726(68.6) | 594 | 68.5 | 632 | 68.7 |
Unable to read | 333(31.4) | 273 | 31.5 | 288 | 31.3 |
Main source of water | |||||
Protected supply | 752(70.8) | 600 | 69.0 | 644 | 69.7 |
Unprotected supply | 310(29.2) | 270 | 31.0 | 280 | 30.3 |
Sanitary condition | |||||
Have toilet facilities | 674(63.3) | 552 | 63.3 | 582 | 62.9 |
No proper toilet facilities | 391(36.7) | 320 | 36.7 | 344 | 37.2 |
Rubbish disposal | |||||
Buries, burns or others | 238(22.4) | 192 | 22.0 | 200 | 21.6 |
Disposes on field | 826(77.6) | 679 | 78.0 | 725 | 78.4 |
Scale of outcome
|
Timing and level of CMD SRQ > = 6 indicating higher level of morbidity
|
Six month time point
|
One year time point
| ||||
---|---|---|---|---|---|---|---|
Nutritional status as binary outcome
| Underweight Number (%) | Stunting Number(%) | Underweight Number(%) | Stunting number(%) | |||
Pregnancy
| |||||||
Low SRQ score | 161(21.0) | 205(26.9) | 167(20.5) | 386(47.8) | |||
High SRQ score | 27(27.6) | 25(25.0) | 28(25.7) | 55(50.9) | |||
P-value* | 0.15 | 0.72 | 0.21 | 0.54 | |||
Two month postnatal
| |||||||
Low SRQ score | 182(22.0) | 220(26.8) | 188(21.4) | 421(48.3) | |||
High SRQ score | 6(15.8) | 10(25.6) | 6(14.3) | 18(43.9) | |||
p-value* | 0.43 | 1.00 | 0.34 | 0.63 | |||
Pregnancy or postnatal
| |||||||
Low SRQ at all time point | 160(21.3) | 201(26.9) | 162(20.5) | 375(47.7) | |||
High SRQ score at both time points | 5(21.7) | 6(25.0) | 2(8.3) | 9(39.1) | |||
High SRQ score at Postnatal only | 1(6.7) | 4(26.7) | 4(22.2) | 9(50.0) | |||
High SRQ score at Pregnancy only | 22(29.3) | 19(25.0) | 26(30.6) | 46(54.1) | |||
p-value* | 0.22 | 0.99 | 0.07 | 0.56 | |||
Nutritional status as continuous outcome
| |||||||
Weight-for-age Z score Mean(SE)
|
Height-for-age Z-score Mean(SE)
|
Weight-for-age Z score Mean(SE)
|
Height-for-age Z-score Mean(SE)
| ||||
Pregnancy
| |||||||
Low SRQ score | -1.08(0.05) | -1.07(0.06) | -1.05(0.04) | -2.03(0.05) | |||
High SRQ score | -1.20(0.14) | -1.17(0.14) | -1.16(0.14) | -2.08(0.17) | |||
P-value* | 0.38 | 0.55 | 0.37 | 0.74 | |||
Two month postnatal
| |||||||
Low SRQ score | -1.10(0.04) | -1.08(0.06) | -1.07(0.04) | -2.03(0.05) | |||
High SRQ score | -0.84(0.18) | -1.15(0.25) | -0.93(0.15) | -2.15(0.24) | |||
p-value* | 0.21 | 0.79 | 0.50 | 0.63 | |||
Pregnancy or postnatal
| |||||||
Low SRQ at all time point | -1.11(0.05) | -1.10(0.06) | -1.06(0.05) | -2.05(0.05) | |||
High SRQ score at both time points | -1.28(0.16) | -1.17(0.15) | -1.32(0.16) | -2.10(0.19) | |||
High SRQ score at Postnatal only | -0.70(0.20) | -1.11(0.41) | -1.27(0.19) | -2.25(0.27) | |||
High SRQ score at Pregnancy only | -0.93(0.27) | -1.18(0.31) | -0.67(0.20) | -2.07(0.38) | |||
p-value* | 0.95 | 0.92 | 0.12 | 0.92 |
Model
| Timing for main exposure |
Six month time point
|
One year time point
| ||
---|---|---|---|---|---|
Underweight OR(95% CI) | Stunting OR(95% CI) | Underweight OR(95% CI) | Stunting OR(95% CI) | ||
Unadjusted | |||||
Never exposed | 1 | 1 | 1 | 1 | |
Pregnancy only | 1.53(0.91, 2.60) | 0.90(0.52, 1.56) | 1.71(1.05, 2.80) | 1.30(0.83, 2.03) | |
Postnatal only | 0.26(0.03, 2.02) | 0.99(0.31, 3.13) | 1.11(0.36, 3.42) | 1.10(0.43, 2.80) | |
Both time points | 1.03(0.38, 2.81) | 0.90(0.35, 2.31) | 0.35(0.08, 1.52) | 0.71(0.30, 1.65) | |
Adjusted for Household characteristics | |||||
Never exposed | 1 | 1 | 1 | 1 | |
Pregnancy only | 1.44(0.82, 2.54) | 0.90(0.51, 1.58) | 1.46(0.86, 2.47) | 1.12(0.70, 1.79) | |
Postnatal only | 0.33(0.04, 2.57) | 0.97(0.30, 3.09) | 1.31(0.41, 4.17) | 1.26(0.28, 3.26) | |
Both time points | 1.09(0.40, 3.03) | 0.89(0.35, 2.29) | 0.32(0.07, 1.40) | 0.68(0.29, 1.62) | |
Maternal characteristics | |||||
Never exposed | 1 | 1 | 1 | 1 | |
Pregnancy only | 1.65(0.95, 2.87) | 0.84(0.47, 1.50) | 1.54(0.91, 2.63) | 1.27(0.79, 2.04) | |
Postnatal only | 0.23(0.03, 1.78) | 0.87(0.27, 2.78) | 0.99(0.32, 3.13) | 1.04(0.40, 2.26) | |
Both time points | 0.98(0.35, 2.73) | 0.82(0.32, 2.14) | 0.30(0.07, 1.30) | 0.69(0.29, 1.63) | |
Infant characteristics | |||||
Never exposed | 1 | 1 | 1 | 1 | |
Pregnancy only | 1.68(0.97, 2.91) | 0.98(0.56, 1.71) | 1.75(1.05, 2.94) | 1.39(0.87, 2.21) | |
Postnatal only | 0.30(0.04, 2.34) | 0.98(0.31, 3.14) | 1.17(0.38, 3.61) | 1.08(0.42, 2.75) | |
Both time points | 0.98(0.36, 2.70) | 0.87(0.34, 2.23) | 0.35(0.08, 1.49) | 0.70(0.30, 1.64) | |
Feeding practices | |||||
Never exposed | 1 | 1 | 1 | 1 | |
Pregnancy only | 1.68 (0.97, 2.91) | 0.98(0.56, 1.71) | 1.75(1.05, 2.93) | 1.39(0.87, 2.21) | |
Postnatal only | 0.30(0.04, 2.34) | 0.98(0.31, 3.14) | 1.17(0.38, 3.61) | 1.08(0.42, 2.75) | |
Both time points | 0.98(0.36, 2.70) | 0.87(0.34, 2.23) | 0.35(0.08, 149) | 0.70(0.30, 1.64) | |
Fully adjusted | |||||
Never exposed | 1 | 1 | 1 | 1 | |
Pregnancy only | 1.43(0.76, 2.71) | 0.86(0.46, 1.62) | 1.07(0.58, 1.97) | 1.14(0.67, 1.96) | |
Postnatal only | 0.21(0.02, 1.86) | 0.67(0.20, 2.27) | 1.07(0.33, 3.62) | 1.06(0.39, 2.94) | |
Both time points | 0.85(0.29, 2.50) | 0.64(0.24, 1.73) | 0.25(0.06, 1.15) | 0.66(0.27, 1.63) | |
From Literature
| |||||
Rahman et al 2004** | Chronic cases | 5.9(2.7, 12.8) | 5.5(1.9, 16.0) | 3.5(2.2, 5.6) | 3.2(1.9, 5.6) |
Model
| Timing for main exposure |
Six month time point
|
One year time point
| ||
---|---|---|---|---|---|
Underweight OR(95% CI) | Stunting OR(95% CI) | Underweight OR(95% CI) | Stunting OR(95% CI) | ||
Unadjusted | |||||
Antenatal | 1.43(0.89,2.30) | 0.91(0.56, 1.46) | 1.34(0.84, 2.12) | 1.13(0.76, 1.70) | |
Postnatal | 0.66(0.27, 1.61) | 0.94(0.45, 1.97) | 0.61(0.25, 1.47) | 0.84(0.45, 1.58) | |
Adjusted for | |||||
Household characteristics | |||||
Antenatal | 1.37(0.83, 2.27) | 0.90(0.55, 1.47) | 1.13(0.69, 1.84) | 1.00(0.65, 1.52) | |
Postnatal | 0.76(0.31, 1.87) | 0.93(0.44, 1.95) | 0.63(0.26, 1.54) | 0.88(0.46, 1.68) | |
Maternal characteristics | |||||
Antenatal | 1.50(0.91, 2.48) | 0.84(0.50, 1.39) | 1.17(0.71, 1.92) | 1.10(0.72, 1.69) | |
Postnatal | 0.60(0.24, 1.47) | 0.85(0.40, 1.80) | 0.53(0.22, 1.29) | 0.80(0.42, 1.52) | |
Infant characteristics | |||||
Antenatal | 1.50(0.92, 2.46) | 0.96(0.59, 1.56) | 1.33(0.82, 2.14) | 1.18(0.78, 1.79) | |
Postnatal | 0.68(0.28, 1.65) | 0.91(0.44, 1.91) | 0.62(0.26, 1.49) | 0.82(0.44, 1.55) | |
Feeding practices | |||||
Antenatal | 1.52(0.93, 2.49) | 0.96(0.59, 1.57) | 1.32(0.82, 2.13) | 1.18(0.78, 1.78) | |
Postnatal | 0.67(0.28, 1.65) | 0.92(0.44, 1.92) | 0.61(0.25, 1.47) | 0.81(0.43, 1.53) | |
Fully Adjusted | |||||
Antenatal | 1.28(0.73, 2.24) | 0.80(0.46, 1.38) | 0.81(0.46, 1.43) | 1.00(0.62, 1.60) | |
Postnatal | 0.56(0.22, 1.46) | 0.66(0.30, 1.45) | 0.52(0.21, 1.32) | 0.80(0.40, 1.59) | |
Available Evidence from relevant Literature
| |||||
Rahman et al 2004 | Antenatal | 3.5(1.5, 8.6) | 3.2(1.1, 9.9) | 3.0(1.5, 6.0) | 2.8(1.3, 6.1) |
Adewuya et al 2008 | Postnatal | 4.21(1.34, 13.20) | 3.34(1.18, 9.55) | ------- | ------- |
Adewuya et al 2008§
| Postnatal | 3.19(1.21, 8.40) | 3.21(1.03 10.47) | ----- | ----- |
Patel et al 2003 ** | Postnatal | Varies between 2.5 and 3.5 | Varies between 3.2 and 3.6 | ------- | ------- |
Rahman et al 2004** | Postnatal | -------- | ------- | 2.8(1.2, 6.8) | ------- |
Anoop et al 2004*** | Postnatal | -------- | ------- | 3.1(0.9, 9.7) | -------- |
Tomlinson et al 2006+ | Postnatal | 0.25(0.03, 2.09) | 1.78(0.69, 4.63) | ||
Tomlinson et al 2006++ | Postnatal | 2.32(0.90, 6.00) | 2.52(0.98, 6.47) | ||
Tomlinson et al 2006+++ | Postnatal | 1.10(0.27, 4.46) | 2.44(0.70, 8.58) | ||
Harpman etal 2005 (ET) | Postnatal | 1.1(0.9, 1.3) | 0.9(0.7, 1.1) | ||
Harpman etal 2005 (PE) | Postnatal | 0.8(0.6, 1.1) | 1.1(0.9, 1.4) | ||
Harpman etal 2005 (VE) | Postnatal | 1.3(1.0, 1.7) | 1.2(0.9, 1.7) | ||
Harpman etal 2005 (IN) | postnatal | 1.1(0.9, 1.3) | 1.4(1.2, 1.6) | ||
Surkan et al 2008§§
| postnatal | 0.6(0.2, 1.7) | 1.8(1.1, 2.8) |