Effect of a Behavioral Change Communication Strategy Coupled With Small‐Quantity Lipid‐Based or Micro‐Nutrient Supplements on Stunting and Obesity in Children in Baja Verapaz, Guatemala: Results From a Cluster Randomized Controlled Trial

The co-existence of childhood stunting and obesity is a public health problem in Guatemala and Latin America. The objective of this study was to assess the effects of unsweetened small-quantity lipid-based nutrient supplements (SQ-LNS) coupled with a behavior change communication (BCC) strategy on the double burden of malnutrition. We conducted a three-arm randomized-control trial with two-stage cluster sampling of households with children under 4.5 months or a mother in the third trimester of pregnancy at baseline from 76 communities in Baja-Verapaz, Guatemala. Some 1268 households were randomly assigned to SQ-LNS or micronutrient powders (MNPs) paired with a multilevel participatory-ludic BCC strategy, or to MNPs only. Measures of mothers' nutrition knowledge and practices were collected at baseline and endline. Children's height, weight, and hemoglobin concentration were measured at endline. Treatment effects were estimated using regression models. The BCC strategy boosted caregiver nutrition knowledge from 4.2 (95% CI: 2.7, 5.7) to 4.6 percentage points (95% CI: 3.1, 6.1). Significant effects on nutrition practices of 3.0 percentage points (95% CI: 1.2, 4.8) were found only for caregivers with children receiving SQ-LNS. We found no detectable treatment effects on stunting or anemia. However, children exposed to SQ-LNS and the BCC strategy were 2.6 percentage points (95% CI: -5.0, -0.2) less likely to be overweight or obese (54.1% lower than the group receiving MNPs only). An intervention coupling a multilevel participatory-ludic BCC strategy with the use of unsweetened SQ-LNS holds promise for the prevention of childhood overweight and obesity, yet complementary interventions are required to address non-nutritional factors related to stunting in Guatemala.