Preventing and treating maternal and childhood malnutrition

We study the biological and non-biological mechanisms underpinning maternal and childhood malnutrition. We also develop innovative interventions to prevent and treat these conditions, and evaluate the efficacy, feasibility and scalability of new interventions.

We carry out a wide range of research, from basic laboratory studies to evaluating implementation of preventive and treatment programmes and support for policy development.

We aim to develop a better understanding of the origins and implications of malnutrition, taking a broad perspective encompassing the many biological and social factors affecting gut health and nutrition.

We have developed ready-to-use supplementary and therapeutic foods based on locally available ingredients (such as rice, lentils and chickpeas), evaluating their acceptability to children, their efficacy and their impact in field trials.

We also work closely with the Government of Bangladesh, analysing barriers to the effective implementation of maternal nutrition programmes and ensuring that national policymaking is based on high-quality evidence.

 

ILEUS RISK

A study of more than 300 severely malnourished children under-five admitted to icddr,b’s Dhaka Hospital identified key factors associated with ileus, a condition characterised by abdominal distension. Ileus affected 15% of such children and was associated with a markedly high risk of death (22% children with ileus versus 8% children without). Ileus was connected with reluctance to feed, septic shock and low

blood potassium levels, while risk of death of severely malnourished children was strongly linked to septic shock. The findings highlight important factors for clinicians to consider when caring for severely malnourished children with diarrhoeal disease.

POLICY AND PRACTICE

A policy analysis has found that Bangladesh has a reasonably well- developed policy environment covering infant and young child feeding, although some significant gaps remain. The study used a matrix developed by the South Asian Infant Feeding Research Network to map the policy landscape and stakeholder network analysis to identify key stakeholders.

A range of measures were proposed to strengthen the policy environment, improve implementation and population coverage, and to enhance engagement with diverse stakeholders.

A separate study examined the extent to which the integration of new National Nutrition Services into existing antenatal care and child healthcare delivery found to enhance both physical and mental development. A trial involving more than 4,000 women, run by icddr,b researchers and US colleagues, found that children grew faster when they and their mothers received lipid-based nutritional supplements, and showed improved motor skills and language development when receiving such supplements. There was no evidence of increased risk of birth complications associated with use of the supplements. Importantly, the trial was integrated into a community- based health programme, emphasising its relevance to real-world settings.

ROTAVIRUS

An analysis of 20 years of monthly data on the causes of diarrhoeal disease, collected at icddr,b’s Dhaka Hospital, has found that a reduction in underweight and wasting among children under-five has been associated with a doubling in the proportion of cases due to rotavirus – from 20% in 1993 to 43% in 2012.

Notably, the study adjusted for climate factors, which also affect rotavirus prevalence. The findings highlight an important consequence of improving nutrition, and reinforces the case for mass rotavirus vaccination.

SUPPLEMENTATION

Lipid-based supplements given to pregnant women and their offspring –covering the critical first 1,000 days from conception to age two – have been found to enhance both physical and mental development. A trial involving more than 4,000 women, run by icddr,b researchers and US colleagues, found that children grew faster when they and their mothers received lipid-based nutritional supplements, and showed improved motor skills and language development when receiving such supplements. There was no evidence of increased risk of birth complications associated with use of the supplements. Importantly, the trial was integrated into a community based health programme, emphasizing its relevance to real-world settings.

ENTERIC DYSFUNCTION

Enrollment has begun into the Bangladesh Environmental Enteric Dysfunction (BEED) study, which aims to validate non-invasive surrogate markers of environmental enteric dysfunction – abnormal gut function thought to be a major cause of growth faltering. Candidate biomarkers will be assessed in blood, urine and fecal samples from children and adults with malnutrition who fail to respond to a nutritional intervention; endoscopic examination will provide a gold standard diagnosis against which the surrogate markers can be compared. The study will identify convenient markers that could be adopted as standard measures for the field, and also reveal possible targets for intervention to correct gut dysfunction.

In newly funded work, icddr,b researchers will also be assessing potential markers of EED in samples collected in the WASH Benefits trial. In addition, a pilot trial is assessing the impact of the nutritional intervention PTM202, a product that contains bovine colostrum and egg from vaccinated hens, on EED in young infants.

ZINC SUPPLEMENTATION

Although micronutrient powders are recommended by World Health Organization for nutritionally vulnerable groups, there is little evidence that they actually improve the growth of young infants, or that zinc supplementation has the expected impact on diarrhoeal disease prevention. A major new trial is systematically assessing the effect of higher concentrations of zinc and different micronutrient supplements on growth and incidence of diarrhoea in young infants.

Report 2017

 

Preventing and treating maternal and childhood malnutrition

We study the biological and non-biological mechanisms underpinning maternal and childhood malnutrition. We also develop innovative interventions to prevent and treat these conditions, and evaluate the efficacy, feasibility and scalability of new interventions.

We carry out a wide range of research, from basic laboratory studies to evaluating implementation of preventive and treatment programmes and support for policy development. We aim to develop a better understanding of the origins and implications of malnutrition, taking a broad perspective encompassing the many biological and social factors affecting gut health and nutrition. We have developed ready-to-use supplementary and therapeutic foods based on locally available ingredients (such as rice, lentils and chickpeas), evaluating their acceptability to children, their efficacy and their impact in field trials. We also work closely with the Government of Bangladesh, analysing barriers to the effective implementation of maternal nutrition programmes and ensuring that national policymaking is based on high-quality evidence. ILEUS RISK A study of more than 300 severely malnourished children under-five admitted to icddr,bs Dhaka Hospital identified key factors associated with ileus, a condition characterised by abdominal distension. Ileus affected 15% of such children and was associated with a markedly high risk of death (22% children with ileus versus 8% children without). Ileus was connected with reluctance to feed, septic shock and low blood potassium levels, while risk of death of severely malnourished children was strongly linked to septic shock. The findings highlight important factors for clinicians to consider when caring for severely malnourished children with diarrhoeal disease. POLICY AND PRACTICE A policy analysis has found that Bangladesh has a reasonably well- developed policy environment covering infant and young child feeding, although some significant gaps remain. The study used a matrix developed by the South Asian Infant Feeding Research Network to map the policy landscape and stakeholder network analysis to identify key stakeholders. A range of measures were proposed to strengthen the policy environment, improve implementation and population coverage, and to enhance engagement with diverse stakeholders. A separate study examined the extent to which the integration of new National Nutrition Services into existing antenatal care and child healthcare delivery found to enhance both physical and mental development. A trial involving more than 4,000 women, run by icddr,b researchers and US colleagues, found that children grew faster when they and their mothers received lipid-based nutritional supplements, and showed improved motor skills and language development when receiving such supplements. There was no evidence of increased risk of birth complications associated with use of the supplements. Importantly, the trial was integrated into a community- based health programme, emphasising its relevance to real-world settings. ROTAVIRUS An analysis of 20 years of monthly data on the causes of diarrhoeal disease, collected at icddr,bs Dhaka Hospital, has found that a reduction in underweight and wasting among children under-five has been associated with a doubling in the proportion of cases due to rotavirus from 20% in 1993 to 43% in 2012. Notably, the study adjusted for climate factors, which also affect rotavirus prevalence. The findings highlight an important consequence of improving nutrition, and reinforces the case for mass rotavirus vaccination. SUPPLEMENTATION Lipid-based supplements given to pregnant women and their offspring covering the critical first 1,000 days from conception to age two have been found to enhance both physical and mental development. A trial involving more than 4,000 women, run by icddr,b researchers and US colleagues, found that children grew faster when they and their mothers received lipid-based nutritional supplements, and showed improved motor skills and language development when receiving such supplements. There was no evidence of increased risk of birth complications associated with use of the supplements. Importantly, the trial was integrated into a community based health programme, emphasizing its relevance to real-world settings. ENTERIC DYSFUNCTION Enrollment has begun into the Bangladesh Environmental Enteric Dysfunction (BEED) study, which aims to validate non-invasive surrogate markers of environmental enteric dysfunction abnormal gut function thought to be a major cause of growth faltering. Candidate biomarkers will be assessed in blood, urine and fecal samples from children and adults with malnutrition who fail to respond to a nutritional intervention; endoscopic examination will provide a gold standard diagnosis against which the surrogate markers can be compared. The study will identify convenient markers that could be adopted as standard measures for the field, and also reveal possible targets for intervention to correct gut dysfunction. In newly funded work, icddr,b researchers will also be assessing potential markers of EED in samples collected in the WASH Benefits trial. In addition, a pilot trial is assessing the impact of the nutritional intervention PTM202, a product that contains bovine colostrum and egg from vaccinated hens, on EED in young infants. ZINC SUPPLEMENTATION Although micronutrient powders are recommended by World Health Organization for nutritionally vulnerable groups, there is little evidence that they actually improve the growth of young infants, or that zinc supplementation has the expected impact on diarrhoeal disease prevention. A major new trial is systematically assessing the effect of higher concentrations of zinc and different micronutrient supplements on growth and incidence of diarrhoea in young infants. Report 2017