A disturbingly high number of young children around the world experience stunted growth
and development with irreparable consequences through the lifespan. Determinants of
stunted growth and development are multi-factorial, including interactions between
biological, behavioral, social, and environmental conditions, yet the evidence-base is
minimal for integrated approaches to tackle the interwoven factors. Our group recently
found significant impacts from an egg intervention on young child growth and biomarkers
of nutrition and brain development. The effects on important psychosocial indicators of
child development, however, were not assessed. Building on these findings and those of
our pilot study of a group-based, multicomponent intervention (Grandi Byen, Haitian
Creole for "grow well"), this randomized controlled trial (RCT) seeks to examine a
greater breadth of egg intervention outcomes, the synergistic effects of adding
psychoeducational parenting to the egg intervention, and mediating biological, behavioral
and social factors.
The 3-arm longitudinal RCT will be carried out in Cap-Haitien, Haiti, where our group has
a decade of research experience, established partnerships, and a strong research
infrastructure. It is representative of resource-poor urban contexts globally, where
parents face common economic and environmental challenges to child growth and
development. The trial will compare the following groups for effectiveness in reducing
young child stunted growth and enhancing overall development: 1) standard well-baby care,
(n=200); 2) nutrition intervention (one egg per day for 6 months), (n=200); and 3)
multicomponent Grandi Byen intervention (responsive parenting, nutrition, hygiene + one
egg per day for 6 months), (n=200). Infants will be enrolled between 6-8 months of age
and followed longitudinally for one year.
The specific aims of this project are:
Aim 1 (primary): To demonstrate the reproducibility and feasibility of egg-based
interventions in reducing childhood stunting, and test its impact on development.
Hypothesis 1: Linear growth will be increased by 0.30 LAZ in children receiving one egg
per day compared to standard care. Hypothesis 2: Children receiving the egg intervention
will have better cognitive, motor and language development compared to standard care.
Question 1 (exploratory): Does an egg-based intervention impact social-emotional
development?
Aim 2 (primary): To investigate the incremental benefit of Grandi Byen compared to egg
only and standard care groups on primary outcomes of child growth and development.
Hypothesis 3: Children of mothers receiving Grandi Byen will increase linear growth by
0.10 LAZ compared to the egg intervention. Hypothesis 4: Children of mothers receiving
Grandi Byen will have higher scores on child cognition, language, motor, and
socio-emotional development, with an effect size of 0.36 on cognition, compared to
standard care. An economic evaluation will be conducted to compare the efficiency of the
interventions.
Aim 3 (secondary). To explore pathways of intervention impacts on child growth and
development by delineating the additive and synergistic effects of biological (nutrient
biomarkers, bone age, and enteric disease), psychosocial (responsive parenting, cognitive
stimulation), and environmental (hygiene and sanitation, diet) factors.
This study expands upon this earlier work by bringing together a transdisciplinary team
spanning the biological and social sciences to work in partnership with Haitian
collaborators. We will merge methods and concepts to produce comprehensive perspectives
on several high priority areas including social, economic and biological factors that
impact child brain development and function, nutrition among infants and very young
children, determinants of bone health; and traumatic stress associated with growing up in
abject poverty.
