SHINE Sanitation, Hygiene, Infant Nutrition Efficacy Project

Primary Investigator

  • Jean Humphrey

Study Period

November 2012 - December 2017

Study Description

Globally, stunting affects 26% (165 million) of under-5-year children, underlies 15-17% of their mortality and leads to long-term cognitive deficits, fewer years and poorer performance in school, lower adult economic productivity, and a higher risk that their own children will also be stunted, perpetuating the problem into future generations. Stunting begins antenatally and peaks at 18-24 months of postnatal life, when mean length-for-age Z-score (LAZ) is about -2.0 among children living in Africa and Asia. Improving the diets of young children can reduce stunting, though, at best, only by about one-third. Frequent diarrheal illness has also been implicated. However, the effect of diarrhea on permanent stunting is relatively small, maybe because children grow at "catch-up" rates between illness episodes. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by a 2-part premise: A major cause of child stunting and anemia is Environmental Enteric Dysfunction (EED). EED is a subclinical disorder of the small intestine, which is virtually ubiquitous among asymptomatic people living in low-income settings throughout the world. EED is characterized by increased permeability which facilitates microbial translocation into the systemic circulation and triggers chronic immune activation. The primary cause of EED is infant ingestion of fecal microbes due to living in conditions of poor quality and quantity of water, sanitation, and hygiene (WASH).

Study Arms

  • Placebo Comparator: Standard of Care
  • Active Comparator: WASH
  • Active Comparator: Nutrition
  • Active Comparator: WASH and Nutrition

Primary Outcomes

  • Infant length at 18 months
  • Infant hemoglobin at 18 months

Study Interventions

  • Behavior change communication (BCC)
  • Environmental enteric dysfunction (EED)
  • Lipid-based nutrient supplements (LNS)
  • Water, sanitation, hygiene (WASH)

Research Gaps

  • Innovation

    What novel food-based products and programming methods effectively prevent and treat undernutrition?

Study Population