The double task of preventing malnutrition and overweight: a quasi-experimental community-based trial

Background: the Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age.Methods: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. the intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. the primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models.Results: 196 children in the intervention group and 263 in the control group were evaluated. the intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI -0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (-0.31, 95%CI -0.49; -0.12) and of BMI-for-age > 85th percentile (0.43, 95%CI 0.23; 0.77) were observed. the intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding.Conclusions: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. the findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.United Nations Children's Fund (UNICEF)Ministry of Public Health of the Dominican Republicpartnership Action for Family Health (Catholic Medical Mission Board)partnership Action for Family Health (Pan-American Health Organization (PAHO/WHO))partnership Action for Family Health (Brystol-Myers Squibb Foundation)Universidade Federal de São Paulo, Nutr Post Grad Program, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Paediat, São Paulo, BrazilSocial & Demog Studies Ctr, Santo Domingo, Dominican RepUniv Fed Pelotas, Postgrad Program Epidemiol, Pelotas, RS, BrazilUniversidade Federal de São Paulo, Nutr Post Grad Program, São Paulo, BrazilWeb of Scienc