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Effect of antenatal and infant micronutrient supplementation on middle childhood and early adolescent development outcomes in Tanzania

European Journal of Clinical Nutrition volume 73, pages 1283–1290 (2019)Cite this article

Subjects

Abstract

Background

There is growing evidence that nutritional interventions in the first 1000 days of life may influence long-term health and development outcomes. Few studies have examined the effect of maternal and infant micronutrient supplementation on development outcomes in sub-Saharan Africa.

Methods

We conducted a follow-up study of two randomized trials of antenatal and infant micronutrient supplementation conducted in Dar es Salaam, Tanzania. We assessed the effect of maternal multiple micronutrient (MMN) supplementation in pregnancy on development of children at 11–14 years of age. We also examined the effect of infant zinc and MMN supplementation on development at 6–8 years of age. We used generalized linear models to assess standardized mean differences (SMDs) in general intelligence, executive function, and mental health scores.

Results

We followed up 446 children whose mothers were enrolled in the maternal MMN supplementation trial and 365 children who were enrolled in the infant zinc and MMN supplementation trial. We found no effect of maternal MMN supplementation on general intelligence (SMD: −0.03; 95% CI: −0.15, 0.09), executive function (SMD: 0.00; 95% CI: −0.11, 0.11), and mental health scores (SMD: 0.06; 95% CI: 10.10, 0.22). We also found no effect of either infant zinc or MMN supplementation on any of the three development domains (p-values > 0.05).

Conclusions

We found that antenatal MMN supplementation and infant zinc and MMN supplementation did not have a large effect on development outcomes in middle childhood and early adolescence in Tanzania.

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Acknowledgements

We would like to thank Muhimbili University of Health and Allied Sciences for their continued support of our research and for allocating special space for the development assessments. We also thank Melba Golmes, Charles Makasi, and the East African Development Tool team for allowing us to use components of the tool and Hadija Nangaboi for leading the training on these assessments. We also thank Dr. Srinivasan Krishnamachari and his team at St. John’s Research Institute for guidance and training on the Verbal Fluency and Kohs Block Design Test. We thank the Research Assistants at MUHAS including Sr. Juliana Mghamba, Sr. Agnes Obedi, Sr. Anna Fundi, Sr. Celestina Kagunila and Sr. Veneranda Ndesangia and sociologists Alice Mabugo and Leah Sabasi. We also thank Mohamed Bakari for developing and maintaining the data system for the study. Finally, we thank the parents and children for their continued participation in the two trials.

Funding

The development follow-up study was funded by the Norwegian Research Council Grant number 234495. The parent randomized trials were funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) (R01 37701 and R01 HD048969-01). CPD was supported by K24DK104676 and P30 DK040561.

Author contributions

WWF, CPD, and KPM were the Principal Investigators of the parent trials. WWF, CPD, KPM, and RK contributed to conduct of the parent trials. TAS, IK, MH WWF, CPD, and KPM designed the development follow-up study and obtained funding. KPM, RK, IK, MH, DCM, TAS, CPD, and WWF were involved in the adaptation and training of the development tool assessments used in the follow-up study. KPM and RK led field implementation of the follow-up study. CRS and AMD conducted the statistical analysis. CRS drafted the initial manuscript. All authors made significant contributions to editing the manuscript and all approved of the final manuscript for submission.

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Author notes

  1. These authors contributed equally: Christopher R. Sudfeld, Karim P. Manji

Authors and Affiliations

  1. Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Christopher R. Sudfeld, Anne Marie Darling, Christopher P. Duggan & Wafaie W. Fawzi

  2. Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Christopher R. Sudfeld, Christopher P. Duggan & Wafaie W. Fawzi

  3. Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Karim P. Manji & Rodrick Kisenge

  4. Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway

    Ingrid Kvestad

  5. Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway

    Mari Hysing

  6. Department of Neurology, Boston Children’s Hospital, Boston, MA, USA

    David C. Belinger

  7. Department of Research, Innlandet Hospital Trust, Lillehammer, Norway

    Tor A. Strand

  8. Faculty of Medicine, Centre for International Health, University of Bergen, Bergen, Norway

    Tor A. Strand

  9. Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Christopher P. Duggan

  10. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA

    Wafaie W. Fawzi

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  1. Christopher R. Sudfeld
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Correspondence to Christopher R. Sudfeld.

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Sudfeld, C.R., Manji, K.P., Darling, A.M. et al. Effect of antenatal and infant micronutrient supplementation on middle childhood and early adolescent development outcomes in Tanzania. Eur J Clin Nutr 73, 1283–1290 (2019). https://doi.org/10.1038/s41430-019-0403-3

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