Efficacy, Effectiveness, and Impact Evaluations
Maternal micronutrient deficiency during pregnancy is one important and preventable risk factor for poor child development, and is prevalent among women of child-bearing age in low- and middle-income countries. In many countries, iron and folic acid supplements are provided as a part of routine pre-natal care. Following a call for evidence for the relative benefit of multiple micronutrients, more than 20 randomized controlled trials have been conducted comparing the recommended formulation of multiple micronutrients to iron and folic acid supplements. While multiple micronutrients have been consistently found to improve birth weight, only three of these trials have measure cognitive and developmental outcomes. In the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), which enrolled >30,000 women in Lombok, Indonesia, we found positive effects on maternal cognition during pregnancy and postpartum, positive effects on child cognition at age 3.5 years in children of undernourished and anemic mothers, and positive effects on procedural memory at school-age (9-12 years), as well as positive effects on general intellectual ability in school-age children of mothers who had been anemic during pregnancy. These findings inform both global policy as well as local health policy, which has been changed from provision of iron and folic acid to provision of multiple micronutrients in several districts in Lombok.
Provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) is a new strategy to reduce infant undernutrition, and its negative developmental consequences. SQ-LNSs (20g or ~110-120 kcal per day) were designed as a type of “home fortification” of complementary foods, to provide key nutrients from age six to 24 months, as children transition from exclusive breastfeeding to sharing the meals of the household. Formulations have also been developed for pregnant and lactating women. While several preliminary trials found positive effects of infant SQ-LNSs on growth and development, the International Lipid-Based Nutrient Supplements (iLiNS) Project was designed to further assess the effectiveness of SQ-LNSs. In four randomized trials enrolling >7000 children and their mothers, we found positive effects of infant SQ-LNSs, together with malaria and diarrhea treatment, on 18-month motor, language, and personal-social development in Burkina Faso, but no effects on 18-month development in Ghana or Malawi. These finding show that populations have varying potential to respond to and benefit from supplementation with SQ-LNSs.
The Mazira Project: An evaluation of eggs during complementary feeding in rural Malawi. Funded by the Bill & Melinda Gates Foundation. PI: Christine Stewart.
International Lipid-Based Nutrient Supplements (iLiNS) DYAD-G preschool follow-up study in Ghana. Funded by the Bill & Melinda Gates Foundation. PI: Kay Dewey.
Impact evaluation of the World Food Program-implemented nutrition program in Malawi. Funded by the Children’s Investment Fund Foundation, through a sub-award from Johns Hopkins University. PI: Kristen Hurley.
Impact evaluation of an integrated poultry value chain and nutrition intervention in Burkina Faso. Funded by the Bill & Melinda Gates Foundation, through a sub-award from the International Food Policy Research Institute. PI: Aulo Gelli.
Publications: Child Development and Cognition
Prado E.L., Sebayang S.K., Apriatni M., Hidayati N., Adawiyah S.R., Islamiyah A., Siddiq S., Harefa B., Alcock K.J., Ullman M.T., Muadz, H., Shankar A.H. (2017). Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children’s cognition at age 9-12 years in Indonesia: follow-up of the SUMMIT randomised trial. The Lancet Global Health, 5(2), e217-e228.
Prado, E. L., Abbeddou, S., Yakes Jimenez, E., Somé, J. W., Ouédraogo, Z. P., Vosti, S. A., et al. (2016). Lipid-based nutrient supplements plus malaria and diarrhea treatment increase infant development scores in a cluster-randomized trial in Burkina Faso. Journal of Nutrition. (Epub ahead of print).
Prado, E. L., Abbeddou, S., Yakes Jimenez, E., Somé, J. W., Dewey, K. G., Brown, K. H., & Hess, S. Y. (2016). Effects of an intervention on growth and development: evidence for different mechanisms at work. Maternal & Child Nutrition. 13(2).
Prado, E. L., Phuka, J., Maleta, K., Ashorn, P., Ashorn, U., Vosti, S. A., & Dewey, K. G. (2016). Provision of lipid-based nutrient supplements from age 6 to 18 months does not affect infant development scores in a randomized trial in Malawi. Maternal & Child Health Journal, 20(10), 2199-2208.
Prado, E. L., Adu-Afarwuah S., Lartey A., Ocansey M., Ashorn P., Vosti S. A., & Dewey, K. G. (2016). Effects of pre- and post-natal lipid-based nutrient supplements on infant development in Ghana. Early Hum Dev, 99, 43-51.
Prado, E. L., Maleta, K., Ashorn, P., Ashorn, U., Vosti, S. A., Sadalaki, J., & Dewey, K. G. (2016). Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi. Am J Clin Nutr, 103(3), 784-793.
Prado, E. L., Alcock, K. J., Muadz, H., Ullman, M. T., & Shankar, A. H. (2012). Maternal multiple micronutrient supplements and child cognition: a randomized trial in Indonesia. Pediatrics, 130(3), e536-546.
Publications: Maternal Cognition and Mental Health
Prado, E. L., Ashorn, U., Phuka, J., Maleta, K., Sadalaki, J., Oaks, B. M., Haskell, M., Allen, L. H., Vosti, S. A., Ashorn, P., Dewey, K. G. (Under Review). Associations of maternal nutrition during pregnancy and postpartum with maternal cognition and caregiving. Maternal & Child Nutrition.
Stewart, R., Ashorn, P., Umar, E., Dewey, K., Ashorn, U., Creed, F., Rahman, A. Tomenson, B., Prado, E. L., Maleta, K. (2016). The impact of maternal diet fortification with lipid-based nutrient supplements on postpartum depression in rural Malawi: a randomised-controlled trial. Maternal & Child Nutrition. 13(2), e12299.
Prado, E. L., Ullman, M. T., Muadz, H., Alcock, K. J., & Shankar, A. H. (2012). The effect of maternal multiple micronutrient supplementation on cognition and mood during pregnancy and postpartum in Indonesia: a randomized trial. PloS one, 7(3), e32519.