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Principal Investigator: Lora Lynn Iannotti
Organization: WASHINGTON UNIVERSITY
Fiscal Year: 2024
Award: $620,841
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
ABSTRACT
A disturbingly high number of young children around the world experience stunted growth and development
with irreparable consequences through the lifespan. Recent estimates show 250 million children less than five
years of age are not reaching their developmental potential, and 151 million have stunted growth.1,2
Determinants of stunted growth and development are multi-factorial, including interactions between biological,
behavioral, social, and environmental conditions, yet the evidence-base is minimal for integrated approaches
to tackle the interwoven factors. Our group recently found significant impacts from an egg intervention on
young child growth and biomarkers of nutrition and brain development. The effects on important psychosocial
indictors of child development, however, were not assessed. Building on these findings and those of our pilot
study of a group-based, multicomponent intervention (Grandi Byen, Haitian Creole for “grow well”), we propose
a larger RCT to examine a greater breadth of egg intervention outcomes, the synergistic effects of adding
psychoeducational parenting to the egg intervention, and mediating biological, behavioral and social factors.
The 3-arm longitudinal RCT, to be carried out in Cap-Haitien, Haiti, where our group has nine years of
research experience, established partnerships, and a strong research infrastructure. It is representative of
resource-poor urban contexts globally, where parents face common economic and environmental challenges
to child growth and development. The trial will compare the following groups for effectiveness in reducing
young child stunted growth and enhancing overall development: 1) multicomponent Grandi Byen intervention
(responsive parenting, nutrition, hygiene + one egg per day for 6 months); 2) nutrition intervention (one egg per
day for 6 months); and 3) standard well-baby care. Infants will be enrolled between 6-8 months of age and
followed longitudinally for one year. The specific aims are:
Aim 1 (primary): To demonstrate the reproducibility and feasibility of egg-based interventions in reducing
childhood stunting, and test its impact on development. Hypothesis 1: Linear growth will be increased by 0.30
LAZ in children receiving one egg per day compared to standard care. Hypothesis 2: Children receiving the
egg intervention will have better cognitive, motor and language development compared to standard care.
Question 1 (exploratory): Does an egg-based intervention impact social-emotional development?
Aim 2 (primary): To investigate the incremental benefit of Grandi Byen compared to egg only and
standard care groups on primary outcomes of child growth and development. Hypothesis 3: Children of
mothers receiving Grandi Byen will increase linear growth by 0.10 LAZ compared to the egg intervention.
Hypothesis 4: Children of mothers receiving Grandi Byen will have higher scores on child cognition, language,
motor, and socio-emotional development, with an effect size of 0.36 on cognition, compared to standard care.
An economic evaluation will be conducted to compare the efficiency of the interventions.
Aim 3 (secondary). To explore pathways of intervention impacts on child growth and development by
delineating the additive and synergistic effects of biological (nutrient biomarkers, bone age, and enteric
disease), psychosocial (responsive parenting, cognitive stimulation), and environmental (hygiene and
sanitation, diet) factors.
This study expands upon this earlier work by bringing together a transdisciplinary team spanning the
biological and social sciences to work in partnership with Haitian collaborators. We will merge methods and
concepts to produce comprehensive perspectives on several high priority areas including social, economic and
biological factors that impact child brain development and function, nutrition among infants and very young
children, determinants of bone health; and traumatic stress associated with growing up in abject poverty.
Terms: <0-11 years old><5 year old><5 years of age><Affect><Age Months><Animal Sources><Area><Behavior><Behavioral><Biologic Factor><Biologic Sciences><Biological><Biological Factors><Biological Markers><Biological Sciences><Bioscience><Brain><Brain Nervous System><Cessation of life><Child><Child Behavior><Child Development><Child Nutrition><Child Rearing><Child Support><Child Youth><Childhood><Children (0-21)><Cognition><Cognitive><Communities><Complementary Feeding><Complex><Data><Death><Development><Diet><Dietary Intervention><Disease><Disorder><Economic Factors><Economical Factors><Economics><Ecuador><Effectiveness><Emotional><Encephalon><Enrollment><Enteral><Enteric><Face><Food><Generalized Growth><Growth><Growth and Development><Growth and Development function><Haiti><Haitian><Height><Hydrogen Oxide><Hygiene><Impairment><Impoverished><Infant><Infant Care><Infant and Child Development><Intervention><Intervention Strategies><Language><Language Development><Length><Life Sciences><Mediating><Methods><Mothers><Motor><NICHD><National Institute of Child Health and Human Development><National Institute of Children's Health and Human Development><Nutrient><Nutrition Interventions><Nutritional Interventions><Outcome><Parenting><Parenting behavior><Parents><Pathway interactions><Personal Satisfaction><Pilot Projects><Population><Poverty><Randomized, Controlled Trials><Reproducibility><Research><Research Infrastructure><Research Resources><Resources><Risk Factors><Sanitation><Site><Social Sciences><Supplementary Feedings><Supplementation><Testing><Tissue Growth><Urban Community><Water><Work><World Health><acceptability and feasibility><acquiring language skills><adolescent trauma><age 5 years><arm><baby care><bio-markers><biologic><biologic marker><biomarker><bone age><bone health><burden of disease><burden of illness><childhood trauma><childrearing><developmental><diarrheal disease><diarrheal illness><diet intervention><diets><disease burden><disease risk><disorder risk><economic><economic analysis><economic assessment><economic evaluation><egg><enroll><evidence base><experience><faces><facial><five year old><five years of age><infant health care><infant healthcare><infection risk><insight><interventional strategy><kids><language acquisition><language learning><life span><lifespan><multi-component intervention><multi-faceted intervention><multi-modal intervention><multicomponent intervention><multifaceted intervention><multimodal intervention><newborn care><nutrition><ontogeny><parent><pathway><pediatric><pediatric nutrition><pediatric trauma><pilot study><pilot test><primary outcome><psychoeducation><psychosocial><randomized control trial><social><social factors><standard care><standard treatment><trauma in children><traumatic stress><trend><well-being><wellbeing><youngster>