Effectiveness of Nutritional Supplementation During the First 1000-Days of Life to Reduce Child Stunting: Results From a Cluster Randomised Controlled Trial in Pakistan

Abstract Objectives We aimed to assess the effectiveness of nutritional supplementation during the first 1000-days on reduction in the prevalence of stunting in children at 24 months of age. Methods In this cluster randomised controlled trial, we enrolled women during their pregnancy from two rural districts of Sindh, Pakistan. A cluster was one union council with a population of ∼25,000 residents. Out of 29 clusters, we randomly allocated 6 clusters to intervention and 6 to control group. Pregnant women received a monthly ration of 5 kg (i.e., 165 grams/day) of wheat soya blend plus (WSB+) during pregnancy and the first six months of their lactation period, and their children received lipid-based nutrient supplement - medium-quantity (LNS-MQ) between 6–23 months of age. The primary outcome was reduction in the prevalence of stunting in children at 24 months of age. Analysis was by intention to treat. The trial is registered in ClinicalTrial.gov, number NCT02422953. Results 2030 pregnant women (1017 in the intervention group and 1013 in the control group) were enrolled between August 30, 2014 and May 25, 2016. Monthly follow-ups were conducted between October 1, 2014 and October 25, 2018. At 24 months of age, data from 702 (78%) of 902 livebirths in the intervention group and 658 (76%) of 860 livebirths in the control group were available. There was a significant difference in mean length (49.4 cm vs 48.9 cm, p = 0.027), weight (3.1 kg vs 3.0 kg, p = 0.013), length for age z-scores (−1.2 vs −1.5, p = 0.004) and weight for age z-scores (−1.2 vs −1.5, p = 0.015) among infants in the intervention compared to control group. At 24 months of age, a significant difference in the prevalence of stunting (absolute difference, −10.2%, 95% CI −18.2 to −2.3, p = 0.017) and underweight (absolute difference, −13.7%, 95% CI −20.3 to −7.0, p = 0.001) were observed in the intervention as compared to the control group. The difference in the prevalence of wasting was not significant between the intervention and control groups (absolute difference, −6.9%, 95% CI −14.1 to −0.3, p = 0.057). Conclusions Provision of WSB + and LNS-MQ during the first 1000-days of life improved child linear growth and reduced stunting in children at 24 months of age. This study can be scaled-up in the similar settings for reduction in the prevalence of stunting in children under-two years of age. Funding Sources World Food Programme.