Child development, growth and microbiota: follow-up of a randomized education trial in Uganda

Prudence Atukunda, Grace K.M. Muhoozi, Tim J. van den Broek, Remco Kort, Lien M. Diep, Archileo N. Kaaya, Per O. Iversen, Ane C. Westerberg

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children's development, growth and gut microbiota at 36 months of age.

Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition.

Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups.

Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings.

Trial registration: ClinicalTrials.gov registration number NCT02098031.

Original languageEnglish
Article number010431
Pages (from-to)1-11
Number of pages11
JournalJournal of global health
Volume9
Issue number1
DOIs
Publication statusPublished - Jun 2019

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Uganda
Microbiota
Child Development
Mothers
Education
Control Groups
Growth
Learning
Language Development
Hygiene
Malnutrition
Language
Demography
Confidence Intervals
Delivery of Health Care
Gastrointestinal Microbiome
Surveys and Questionnaires

Cite this

Atukunda, P., Muhoozi, G. K. M., van den Broek, T. J., Kort, R., Diep, L. M., Kaaya, A. N., ... Westerberg, A. C. (2019). Child development, growth and microbiota: follow-up of a randomized education trial in Uganda. Journal of global health, 9(1), 1-11. [010431]. https://doi.org/10.7189/jogh.09.010431
Atukunda, Prudence ; Muhoozi, Grace K.M. ; van den Broek, Tim J. ; Kort, Remco ; Diep, Lien M. ; Kaaya, Archileo N. ; Iversen, Per O. ; Westerberg, Ane C. / Child development, growth and microbiota: follow-up of a randomized education trial in Uganda. In: Journal of global health. 2019 ; Vol. 9, No. 1. pp. 1-11.
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abstract = "Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children's development, growth and gut microbiota at 36 months of age.Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition.Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95{\%} confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups.Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings.Trial registration: ClinicalTrials.gov registration number NCT02098031.",
author = "Prudence Atukunda and Muhoozi, {Grace K.M.} and {van den Broek}, {Tim J.} and Remco Kort and Diep, {Lien M.} and Kaaya, {Archileo N.} and Iversen, {Per O.} and Westerberg, {Ane C.}",
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Atukunda, P, Muhoozi, GKM, van den Broek, TJ, Kort, R, Diep, LM, Kaaya, AN, Iversen, PO & Westerberg, AC 2019, 'Child development, growth and microbiota: follow-up of a randomized education trial in Uganda' Journal of global health, vol. 9, no. 1, 010431, pp. 1-11. https://doi.org/10.7189/jogh.09.010431

Child development, growth and microbiota: follow-up of a randomized education trial in Uganda. / Atukunda, Prudence; Muhoozi, Grace K.M.; van den Broek, Tim J.; Kort, Remco; Diep, Lien M.; Kaaya, Archileo N.; Iversen, Per O.; Westerberg, Ane C.

In: Journal of global health, Vol. 9, No. 1, 010431, 06.2019, p. 1-11.

Research output: Contribution to JournalArticleAcademicpeer-review

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AU - Atukunda, Prudence

AU - Muhoozi, Grace K.M.

AU - van den Broek, Tim J.

AU - Kort, Remco

AU - Diep, Lien M.

AU - Kaaya, Archileo N.

AU - Iversen, Per O.

AU - Westerberg, Ane C.

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N2 - Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children's development, growth and gut microbiota at 36 months of age.Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition.Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups.Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings.Trial registration: ClinicalTrials.gov registration number NCT02098031.

AB - Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children's development, growth and gut microbiota at 36 months of age.Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition.Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups.Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings.Trial registration: ClinicalTrials.gov registration number NCT02098031.

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