Supplementary feeding and infection control in pregnant adolescents in Sierra Leone
This is a summary of the following paper: Koroma A, Ellie M, Bangura K et al (2023) Supplementary feeding and infection control in pregnant adolescents – A secondary analysis of a randomised trial among malnourished women in Sierra Leone. Maternal & Child Nutrition, 19, e13456. https://doi.org/10.1111/mcn.13456
Undernutrition in pregnancy during adolescence carries a high risk of maternal morbidity and poor birth outcomes. This study performed a secondary data analysis to test the hypothesis that, during pregnancy, undernourished adolescents would benefit more than adults from an intervention consisting of a daily ration of supplementary food and anti-infective treatments.
The original randomised controlled trial was conducted in Sierra Leone and enrolled 236 younger adolescents (aged under 18 years), 454 older adolescents (aged 18–19 years) and 741 adults (aged 20 years or above), all with a mid-upper arm circumference of 23cm or more. Both control and intervention groups received treatment, albeit under different regimens. The intervention arm received antibiotic and antimalarial treatment at multiple stages of pregnancy, plus a daily ration of ready-to-use supplemental food throughout (18g protein and a broad range of micronutrients). The control arm received daily corn-soy blended flour, palm oil and a sharing ration in line with World Food Programme standards (17.5g protein), plus iron and folic acid during the second and third trimesters.
When evaluating outcomes, irrespective of the intervention group, younger adolescents had a similar rate of weight change compared to adult mothers. Younger adolescent mothers had newborns with lower birth weight, length and mid-upper arm circumference, as well as higher proportions of blow birth weight and stunted newborns compared to adult mothers.
Overall, while the intervention proved effective when all ages were pooled together, there were significant differences in effect between each maternal age group. These results were not as expected. Younger adolescent mothers benefited less from the combined intervention than adult mothers regarding the rate of weight gain during pregnancy and infant birth weight, length and rate of low birth weight. Younger adolescents also benefited less than older adolescents, although differences did not reach statistical significance.
The findings reinforce what has been seen in other studies: that younger adolescent mothers tend to give birth to babies with lower birth weight, length and mid-upper arm circumference than adult mothers. These findings do not, however, indicate that supplementary food is not beneficial when treating undernourished adolescents, as the analysis was not structured as supplementary food versus no supplementary food, so the results should be viewed with care.
There were limitations to the study. As a post hoc analysis (conducted after the dataset was already viewed), the incidence of multiple testing increased the chance of false positive results. Strengths included a large sample size and a robust design of the original trial. Further investigation is required to determine if the findings are comparable in different environments, as this was conducted in a rural West African context.
The findings may suggest that there are unaddressed barriers to nutrient transfer, improved length of gestation and/or other factors essential for foetal development. Holistic care – including nutritional, anti-infective and mental health care, as well as social support – may be necessary to attain optimal birth outcomes, especially in the most vulnerable young adolescents.
More like this
FEX: The link between foetal and childhood nutrition and adult non-communicable disease: lessons from birth cohort studies in India
View this article as a pdf Research summary1 Location: India What we know: Non-communicable diseases (NCDs) are rising in prevalence globally and they particularly affect...
FEX: Anthropometric cut-off points for older children and adolescents in Syria
By Paluku Bahwere View this article as a pdf Paluku Bahwere is a paediatrician with over 25 years of experience in operational research and programming in the fields of...
en-net: MUAC and oedema
Hi there, I have read several times in this forum that MUAC is NOT affected by oedema or pregnancy. I can not find any study about it. Could anyone give me some references...
FEX: Intergenerational cycle of acute malnutrition among IDPs in Somalia
By Samson Desie Samson Desie is a nutrition specialist who has worked in the sector for more than a decade and currently works as Nutrition Cluster Coordinator with UNICEF...
FEX: Concerns that The Lancet double-burden series may undermine moderate wasting treatment
View this article as a pdf By Mark Manary, Donna Wegner, D Taylor Hendrixson, Rebecca Roediger, Meghan Callaghan Mark Manary is one of the world's foremost experts in...
FEX: Maternal mid-upper arm circumference: Still relevant to identify adverse birth outcomes in humanitarian contexts?
View this article as a pdf Sonia Kapil is a former Graduate Researcher at Emory University, Rollins School of Public Health Mija Ververs is a Senior Associate at the Center...
Resource: Women's nutrition: A summary of evidence, policy and practice including adolescent and maternal life stages
Please scroll down for links to download the Executive Summary (also available in French) and full report Lisez cet document d'information technique en français ici...
en-net: Maternal nutrition
What interventions are available for maternal Nutrition A life cycle approach would be preferable that can break the inter-generation of malnutrition. As you may know...
FEX: Food for thought: Supplementary feeding programme or ‘antenatal feeding programme’ for pregnant women
By Michael H Golden Michael Golden is Emeritus Professor at the University of Aberdeen, Scotland. An independent physician and researcher, he has over 40 years of experience...
FEX: Preventing teen pregnancies and supporting pregnant teenagers in Ecuador
View this article as a pdf By Sara Bernardini, Geraldine Honton, Laura Irizarry, Jesús Sanz, Estefanía Castillo, Carmen Guevara and Lorena Andrade Sara...
FEX: Effect of adding RUSF to ageneral food distribution on child nutritional status and morbidity: a cluster randomised controlled trial
Summary of research1 Child during appetite test at a health facility offering treatment in Monrovia, Liberia The authors of a recent study hypothesized that including a daily...
NEX: Breaking the cycle of malnutrition: Designing an adolescent programme in Nepal
Lisez cet article en français ici View this article as a pdf Min Raj Gyawali is the Senior Manager for Health Services with the Suaahara II programme in...
FEX: Short children with a low MUAC respond to food supplementation: an observational study from Burkina Faso
By Fabiansen, C., Phelan, Kevin, P.Q., Cichon, B., Ritz, C., Briend, A., Michaelsen, K.F., Friis, H. and Shepherd, S Summary of research: Short children with a low midupper...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
View this article as a pdf Lisez cet article en français ici By Zivai Murira and Harriet Torlesse Zivai Murira is Nutrition Specialist at United Nations Children's...
FEX: Research Snapshots
The following provides a short summary of each of these important research studies. A fuller summary of each can be found online at www.ennonline.net/fex Inpatient management...
FEX: Ensuring pregnancy weight gain: An integrated community-based approach to tackle maternal nutrition in India
View this article as a pdf Lisez cet article en français ici By Sreeparna Ghosh Mukherjee, Pia Sen and Dr Nagma Nigar Shah Sreeparna Ghosh Mukherjee is Senior...
NEX: Meeting the health and nutrition needs of adolescents and youth in Ethiopia
View this article as a pdf Lisez cet article en français ici Meseret Zelalem is a paediatrician and Director of the Maternal and Child Health Directorate of the...
FEX: Adolescent inclusion in the Care Group approach: the Nigeria experience
By Shiromi Michelle Perera Shiromi Michelle Perera is a Technical Officer with the Nutrition, Food Security and Livelihoods Unit at International Medical Corps, Washington...
Combining a mid-day meal, health service package and peer support in Karnataka State, India
Combining a mid-day meal, health service package and peer support in Karnataka State, India View this article as a pdf Uma Mahadevan is Principal Secretary in the Department...
FEX: Feeding the unborn babies
By Severin Kabakama Dr Severin Kabakama (MD Dar) is Assistant Project Officer (Early Child Development) in the Western Tanzania Refugee Program, UNICEF Kasulu Field Office. He...
Reference this page
Supplementary feeding and infection control in pregnant adolescents in Sierra Leone. Field Exchange 69, May 2023. p31. www.ennonline.net/fex/69/supplementary-feeding-and-infection-control-in-pregnant-adolescents-in-sierra-leone
(ENN_7600)