Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster-randomized trial

Stunting is associated with impaired cognitive and motor function. The effect of an education intervention including nutrition, stimulation, sanitation, and hygiene on child growth and cognitive/language/motor development, delivered to impoverished mothers in Uganda, was assessed. In a community-based, open cluster-randomized trial, 511 mother/children dyads aged 6-8months were enrolled to an intervention (n=263) or control (n=248) group. The primary outcome was change in length-for-age z-score at age 20-24months. Secondary outcomes included anthropometry and scores on the 2 developmental scales: Bayley Scales of Infant and Toddler Development-III and the Ages and Stages Questionnaire. There was no evidence of a difference in mean length-for-age z-score at 20-24months between the 2 study groups: 0.10, 95% CI [-0.17, 0.36], p=.49. The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development-III, the mean difference being 15.6, 95% CI [10.9, 20.2], p=.0001; 9.9, 95% CI [6.4, 13.2], p=.0001; and 14.6, 95% CI [10.9, 18.2], p=.0001, for cognitive, language, and motor composite scores, respectively. The mean difference in scores from the Ages and Stages Questionnaire were 7.0, 95% CI [2.9, 11.3], p=.001; 5.9, 95% CI [1.2, 10.3], p=.01; 4.2, 95% CI [1.7, 6.7], p=.001; 8.9, 95% CI [5.3, 12.3], p=.0001; and 4.4, 95% CI [0.0, 8.8], p=.05, for communication, gross motor, fine motor, problem solving, and personal-social development, respectively. The intervention education delivered to mothers promoted early development domains in cognitive, language, and motor development but not linear growth of small children in impoverished rural communities in Uganda. Our study showed that child development may be improved with a relatively low cost intervention strategy. This trial was registered at as NCT02098031.