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  • Growth and body composition of children aged 2–4 years after exposure to community mobilisation women’s groups in Bangladesh

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Growth and body composition of children aged 2–4 years after exposure to community mobilisation women’s groups in Bangladesh
  1. Edward Fottrell1,
  2. Naveed Ahmed2,
  3. Badrun Nahar2,
  4. Sanjit Kumer Shaha2,
  5. Abdul Kuddus2,
  6. Carlos S Grijalva-Eternod1,
  7. Tasmin Nahar2,
  8. Caroline Fall3,
  9. Clive Osmond3,
  10. Virginia Govoni4,
  11. Sarah Finer4,
  12. Chittaranjan Yajnik5,
  13. A K Azad Khan2,
  14. Anthony Costello1,6,
  15. Kishwar Azad2,
  16. Graham A Hitman4
  1. 1Institute For Global Health, University College London, London, UK
  2. 2Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
  3. 3MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  4. 4Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  5. 5Diabetes Unit, King Edward Memorial Hospital, Pune, India
  6. 6WHO Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland
  1. Correspondence to Dr Edward Fottrell, Institute For Global Health, University College London, London WC1N 1EH, UK; e.fottrell{at}ucl.ac.uk

Abstract

Background Women’s groups interventions in Bangladesh reduced neonatal deaths by 38% and improved hygienic delivery, newborn care practices and breast feeding. We explore the longer-term impact of exposure to women’s groups during pregnancy on child growth at 2–4 years.

Methods We performed a cross-sectional survey of child anthropometric measures (analysed as z-scores) among children born to women who had participated in the women’s groups interventions while pregnant, compared with an age-matched and sex-matched sample of children born to control mothers. Results were stratified by maternal body mass index (BMI) and adjusted for possible confounding effects of maternal education, household asset ownership and, in a separate model, mother-child height difference, a proxy for improved survival of small babies in intervention groups.

Results Data were obtained from 2587 mother-child pairs (91% response). After adjustment for asset ownership, maternal education and potential survival effects, children whose mothers were exposed to the women’s group intervention had higher head (0.16 (0.04 to 0.28)), mid-upper arm (0.11 (0.04 to 0.19)), abdominal (0.13 (0.00 to 0.26)) and chest (0.18 (0.08 to 0.29)) circumferences than their control counterparts. No significant differences in subcutaneous fat (subscapular and triceps skinfold thickness) were observed. When stratified by maternal BMI, intervention children had higher weight, BMI and circumferences, and these effects decreased with increasing maternal BMI category.

Conclusions Women’s groups appear to have had a lasting, positive impact on child anthropometric outcomes, with most significant results clustering in children of underweight mothers. Observed differences are likely to be of public health significance in terms of the nutritional and metabolic development of children.

  • Developing Countr
  • Growth
  • Lifecourse / Childhood Circumstances
  • Public Health
  • Social And Life-course Epidemiology

https://doi.org/10.1136/jech-2017-210134

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    Footnotes

    • Contributors EF, NA, AC, KA, SF and GAH developed the study protocol. EF and NA prepared the first draft of the manuscript; EF coordinated revisions and prepared the final manuscript draft. NA and SKS coordinated field work and data capture activities. BN managed data processes. TN coordinated the original participatory women’s groups intervention and managed data on individual women’s participation and attendance in groups. EF led statistical analysis with BN and with technical input from CF, CSG-E and CO. CF contributed to anthropometric protocol development and fieldworker training. AK and KA provided overall leadership and coordination of the project in Bangladesh. KA and AC were principal investigators of the original PWG trial and, together with CF, CSG-E, SF, VG, AK and GAH, contributed substantially to the interpretation of the study findings. All authors reviewed, contributed to and approved the final manuscript.

    • Funding The research leading to these results has received funding from the European Union’s Seventh Framework Programme under EC-GA No. 278917 (GIFTS).

    • Disclaimer The funder played no part in the study design, data collection, analysis, interpretation of results, writing the report or the decision to submit for publication.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the Institutional Ethical Review Board of the Diabetic Association of Bangladesh (BADAS ERC/EC/13/00108). The original PWG trial was approved by the University College London research ethics committee (identification no. 1488/001).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data sets generated and analysed during this study are available from the corresponding author on reasonable request.