To assess the effectiveness of nutritional supplementation during the first 1000-days to reduce the prevalence of low birth weight and stunting in children at 24 months of age.
In this cluster randomized controlled trial, we enrolled women from two rural districts of Pakistan during their pregnancy. Out of 29 clusters, we randomly allocated 6 clusters to the intervention and control each. Pregnant women received a monthly supply 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. In addition, their children received lipid-based nutrient supplement - medium-quantity (LNSMQ) between 6-23 months of age.
Two thousand thirty pregnant women (1017 in the intervention group and 1013 in the control group) were enrolled. Monthly follow-ups were conducted. At 24 months of age, we captured data from 699 (78%) of 892 live births in the intervention group and 653 (76%) of 853 live births in the control group. 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.
Provision of supplementation during the first 1000-days of life improved child linear growth and reduced stunting in children at 24 months. This intervention can be scaled-up in similar settings to lower the prevalence of low birthweight and stunting in children under two years of age.