Sherlie Jean-Louis Dulience’s research while affiliated with Washington University in St. Louis and other places

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Publications (9)


Conceptual Model of Mediating Mechanisms
Hypothesized pathways from study conditions to outcomes
Cap-Haitien and surrounding communities. Map by E.A. Gyimah
Randomization Scheme
Grandi Byen—supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial
  • Article
  • Full-text available

January 2022

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305 Reads

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11 Citations

BMC Pediatrics

Patricia L. Kohl

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Jenna Diaz

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Background Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development. Methods We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions. Discussion This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally. Trial registration NCT04785352. Registered March 5, 2021 at https://clinicaltrials.gov/

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Map of Haiti that shows school locations in urban and rural areas
Modified from Worldatlas.com.
Sociodemographic and morbidity characteristics of urban and rural Haitian school-aged children¹, ²
Effect modification with logistic generalized linear mixed model in anemia¹
Differences in factors associated with anemia in Haitian children from urban and rural areas

April 2021

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218 Reads

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9 Citations

Background In Haiti, differences in the prevalence of anemia between urban and rural areas have been observed. Objective To identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti. Methods This cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5–13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect. Results In rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, (x¯ = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32–3.18)], age [AOR = 0.89; 95%CI (0.85–0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67–0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed. Conclusions In this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.


A Cross-Sectional Needs Assessment of Adolescent Physical Activity in the Early Nutrition Transitioning Country of Haiti (P16-006-19)

June 2019

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22 Reads

Current Developments in Nutrition

Objectives: An exploratory assessment of physical activity (PA) to identify covariates of PA behaviors in Haitian adolescents. Methods: Students from two urban schools participated in two different data collection methodologies: a self-reported survey (n = 100) assessing school, transportation, and leisure-time PA; an objective accelerometry study (n = 55). Self-reported diet behaviors were also collected. Parent and non-parent caregivers reported demographic data. Logistic regression identified potential correlates of PA; PA was operationalized as meeting the World Health Organization's recommendation (WHO REC) of ≥60 minutes of moderate/vigorous PA per day for adolescents. Results: Self-reported data. The school PA model showed age (OR = 2.03; 95% CI = 0.66, 6.31), gender (OR = 1.41; 95% CI = 0.40, 4.97), and dietary diversity score ([DDS]; OR = 1.49; 95% CI = 1.17, 1.90) were significantly associated with WHO REC. Age (OR = 1.90; 95% CI = 1.55, 6.53), gender (OR = 1.22; 95% CI = 1.19, 3.03), DDS (OR = 1.25; 95% CI = 0.99, 1.57), and caregiver's occupation in the market (OR = 5.66; 95% CI = 1.27, 25.20) were significant correlates of WHO REC in the transportation PA model. The leisure-time PA model found gender (OR = 3.95; 95% CI = 1.09, 14.33), DDS (OR = 1.37; 95% CI = 1.09, 1.74), and bringing a snack/meal to school (OR = 4.17, 95% CI = 1.18, 14.67) to be significant covariates of WHO REC. Objective data. The model of accelerometry PA identified age (OR = 4.17; 95% CI = 1.31, 55.79), gender (OR = 48.19; 95% CI = 22.16, 77.92; female reference group), DDS (OR = 4.48; 95% CI = 1.12, 16.76), and household access to a flush toilet (OR = 0.03; 95% CI = 0.46, 64.45) as significant correlates of WHO REC. Conclusions: As nutrition transition is underway in Haiti, so is the onset of the dual burden of malnutrition; PA can alleviate the negative health consequences of both phenomena, but heretofore such data have been unavailable for Haiti. Results support a) early adoption of policies and programs for PA and nutrition together and b) future investigation into Haitian PA behaviors and their sociocultural determinants. Funding sources: This study was funded by the Public Health Cubed Grant of the Washington University Institute of Public Health and the Brown School of Social Work International Dissertation Research Award.


Socioeconomic, Dietary and Health Determinants of Body Composition in Haitian School Children Aged 3–13 Years (P11-130-19)

June 2019

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39 Reads

Current Developments in Nutrition

Objectives: This study aimed to characterize socioeconomic, dietary and health factors associated with body composition of school-aged children in Cap-Haïtien, Haiti. Methods: Baseline data from a cluster randomized controlled trial of children aged 3-13 years (n = 1084) to test the effectiveness of lipid-based nutrient supplement on anemia and other nutrition outcomes was used for this analysis. Anthropometric measures of height and weight were collected from the children using standard WHO protocols. Parent surveys provided information on household-level socioeconomic and demographic information and frequency of dietary intakes and infectious disease morbidities of the children. Body composition was determined using bioelectric impedance analysis (BIA). Equations, validated using deuterium dilution method in Gambian school children, were then used to derive fat mass (FM) and fat free mass (FFM). Multiple linear regression modeling identified factors associated with body composition. Results: There were 43.7% of children categorized as moderately thin (body mass index (BMI) z score < -1). Mean percentage of FM was 7.8% (SD ± 3.5) and 11.9% (SD ± 4.9) while mean FM (kg) was 1.7kg (SD ± 0.8) and 3.1kg (SD ± 3.5) for thin children and those not thin, respectively. Child's age, ear infection in the last month and bread consumption were negatively associated with FM (%), whereas child's sex, maternal BMI, and toilet type used showed a positive relationship. FM (kg) was positively associated with child's age, sex, height-for-age z score, maternal BMI, house ownership and toilet type used. Models 1, 2, and 3 with BMI z score, FM (%) and FM (kg) as dependent variables respectively showed: [F(6, 773) = 16.2, β = -1.5, P < .001, (Adj. R2 = .11)], [F(6, 747) = 42.2, β = 2.7, P < .001, (Adj. R2 = .25)] and [F(6, 746) = 36.0, β = -2.7, P < .001, (Adj. R2 = .22)]. Conclusions: This study provides evidence of socioeconomic, dietary and health factors associated with body composition in Haitian school-aged children, however more research is required to identify additional factors mediating this relationship. Funding sources: Supported by the USDA Foreign Agricultural Service Micronutrient Fortified Food Aid Products program FFE-521-2012/034-00, the Masters Research Fellows Program of the Brown School and E3 Nutrition Lab.


Fig 1. Flow diagram of Vita Mamba trial in Haitian school children. Formative research identified eligible communities based on a set of criteria. The two selected communities were randomly assigned to one of the two study arms. After parents were informed, eligible children were recruited and enrolled. Parents were surveyed on socio-economic and demographic characteristics, child diet, and child morbidities at baseline, and children were followed at two time points, baseline and endline, for measures of Hb concentration, height, and weight. Data was analyzed for intervention effects using regression modeling including kernel-based matching (KBM) and propensity score weighting (PSW). 
Fortified Snack Reduced Anemia in Rural School-Aged Children of Haiti: A Cluster-Randomized, Controlled Trial

December 2016

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117 Reads

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16 Citations

Background: Nutrition in the school-aged child matters for brain development and public policy investments globally. Our group previously conducted a trial in urban schools of Haiti to examine the effects of a fortified peanut butter snack, Vita Mamba, with limited findings for anemia. Objective: We aimed to test the hypothesis that Vita Mamba, with systematic deworming in both study arms, would significantly reduce anemia among rural, school-aged children. Methods: A cluster, randomized longitudinal study was conducted in two rural communities of the North-East Department of Haiti, 2014-2015. Healthy children ages 3-16 years were enrolled (n = 321) and assigned by school to intervention (Vita Mamba and deworming) and control (deworming). Vita Mamba contains 260 kcal and meets >75% of the Recommended Dietary Allowance for critical micronutrients. Multivariate regression analyses including propensity score matching techniques to correct for potential group imbalance (Kernel-based Matching and Propensity Score Weighting) were applied to examine difference-in-difference intervention effects. Results: At baseline, 51% of the children were anemic with no significant differences between study groups. Vita Mamba supplementation showed a consistent, positive effect across regression models on increasing Hb concentration and reducing the odds of anemia compared to the control group after adjusting for child age, vitamin A supplementation, milk consumption, and height-for-age z score. The average treatment effect for the treated in the Propensity Score Weighting models was 0.62±0.27 grams per 100 milliliters (g/dL) for Hb concentration (F = 4.64, P = 0.001), and the odds of anemia were reduced by 88% (Wald χ² = 9.77, P = 0.02). No differences in change in anthropometric markers were evident. Conclusions: School feeding programs that integrate fortified foods with deworming could reduce anemia burden with important implications for learning, health, and well-being. The rural-urban differences in anemia require further study.





Nutrition factors predict earlier acquisition of motor and language milestones among young children in Haiti

May 2016

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54 Reads

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22 Citations

Acta Paediatrica

Aim: To examine the nutrition-related factors associated with motor and language development among young children living in a poor urban area of Haiti. Methods: Children aged 6-11 months (n = 583) were enrolled and followed monthly for one year. World Health Organization motor developmental milestones and vowel and consonant counts were assessed. Longitudinal regression models were applied to assess the association of anthropometric, dietary intake, infectious disease morbidity and socio-economic and demographic factors on developmental outcomes. Results: At baseline, 9.4% were stunted or length-for-age Z score < -2, and 30.2% were mild-to-moderately stunted or length-for-age Z score < -1. Stunting status was significantly associated with motor and phonetic language acquisition at each time point during infancy. Several nutrition factors significantly predicted earlier achievement of motor and language development outcomes in longitudinal models: child anthropometry; breastfeeding and complementary feeding frequencies; dietary diversity; egg and oil intake and reduced infectious disease morbidities. Increases in the length-for-age Z score significantly predicted all motor and language outcomes and yielded the best fit models compared to other anthropometric indicators (p < 0.001). Conclusion: Child development interventions may be enhanced by incorporating nutrition strategies such as improved diet quality, breastfeeding promotion and diarrheal disease mitigation. This article is protected by copyright. All rights reserved.

Citations (4)


... Makanan tambahan berperan penting dalam memperbaiki status gizi balita stunting (Kohl et al., 2022;Sisay & Tesfaye, 2023). Makanan tambahan yang efektif harus mengandung nutrisi penting seperti protein, vitamin, dan mineral yang dibutuhkan untuk pertumbuhan dan perkembangan optimal (French et al., 2020). ...

Reference:

Mutu Organoleptik dan Tingkat Penerimaan Produk Food Bars Substitusi Tepung Kelor, Lamtoro, dan Bonggol Jagung sebagai Makanan Tambahan Balita Stunting
Grandi Byen—supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial

BMC Pediatrics

... Therefore, if children consume such ASFs it might exacerbate anemia by exposing the children to illness and inflammation caused by the pathogens (Lambrecht et al. 2021). Another probable reason for this could be, the presence of intestinal parasites among the children which lead to helminthic infections, diarrhea, dysentery and intestinal malabsorption (Palacios et al. 2021). Thus, despite the consumption of ASF, if the children have these parasites, they will still be more susceptible to anemia. ...

Differences in factors associated with anemia in Haitian children from urban and rural areas

... Studies were conducted in seventeen countries. Twenty-four studies were conducted in the Caribbean: nine in Haiti [29,[33][34][35][36]38,50,57,67], three in Cuba [62,63,72], three in Dominican Republic [37,44,64], three in Jamaica [24,32,69], three in Trinidad and Tobago [25,55,68], two in Puerto Rico [49,71] and one in Barbados [70]. Eighteen studies were conducted in the Atlantic, Indian Ocean, Mediterranean and South China Sea (AIMS region): fifteen in Singapore [26,28,30,31,42,43,51,54,58,60,61,65,66,73,74] , two in Mauritius [39,41] and one in Seychelles [27]. ...

Fortified Snack Reduced Anemia in Rural School-Aged Children of Haiti: A Cluster-Randomized, Controlled Trial

... 8,9 Banyak penelitian yang telah mengamati hubungan antara nutrisi dan perkembangan anak di lingkungan dengan sumber daya yang terbatas menemukan bahwa pola makan yang buruk dan status gizi berhubungan dengan perkembangan. 10,11 Studi lain melaporkan bahwa status gizi signifikan terhadap perkembangan anak balita (p = 0,003). 12 Sebanyak 90% balita dengan motorik kasarnya suspek memiliki status gizi kurang. ...

Nutrition factors predict earlier acquisition of motor and language milestones among young children in Haiti
  • Citing Article
  • May 2016

Acta Paediatrica