Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children.

We aimed to analyse growth and recovery from undernutrition among moderately underweight ambulatory children receiving micronutrient-fortified maize-soy flour (Likuni Phala, LP) or ready-to-use fortified spread (FS) supplementary diet. One hundred and seventy-six 6-18-month-old individuals were randomized to receive 500 g LP or 350 g FS weekly for 12 weeks. Baseline and end of intervention measurements were used to calculate anthropometric gains and recovery from underweight, wasting and stunting. Mean weight-for-age increased by 0.22 (95% CI 0.07-0.37) and 0.28 (0.18-0.40) Z-score units in the LP and FS groups respectively. Comparable increase for mean weight-for-length was 0.39 (0.20-0.57) and 0.52 (0.38-0.65) Z-score units. Recovery from underweight and wasting was 20% and 93% in LP group and 16% and 75% in FS group. Few individuals recovered from stunting and mean length-for-age was not markedly changed. There were no statistically significant differences between the outcomes in the two intervention groups. In a poor food-security setting, underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize-soy flour porridge show similar recovery from moderate wasting and underweight. Neither intervention, if limited to a 12-week duration, appears to have significant impact on the process of linear growth or stunting

Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians.

OBJECTIVE: To compare growth and incidence of malnutrition in infants receiving long-term dietary supplementation with ready-to-use fortified spread (FS) or micronutrient-fortified maize-soy flour (likuni phala [LP]). DESIGN: Randomized, controlled, single-blind trial. SETTING: Rural Malawi. PARTICIPANTS: A total of 182 six-month-old infants. INTERVENTION: Participants were randomized to receive 1 year of daily supplementation with 71 g of LP (282 kcal), 50 g of FS (FS50) (256 kcal), or 25 g of FS (FS25) (130 [corrected] kcal). OUTCOME MEASURES: Weight and length gains and the incidences of severe stunting, underweight, and wasting. RESULTS: Mean weight and length gains in the LP, FS50, and FS25 groups were 2.37, 2.47, and 2.37 kg (P = .66) and 12.7, 13.5, and 13.2 cm (P = .23), respectively. In the same groups, the cumulative 12-month incidence of severe stunting was 13.3%, 0.0%, and 3.5% (P = .01), of severe underweight was 15.0%, 22.5%, and 16.9% (P = .71), and of severe wasting was 1.8%, 1.9%, and 1.8% (P > .99). Compared with LP-supplemented infants, those given FS50 gained a mean of 100 g more weight and 0.8 cm more length. There was a significant interaction between baseline length and intervention (P = .04); in children with below-median length at enrollment, those given FS50 gained a mean of 1.9 cm more than individuals receiving LP. CONCLUSION: One-year-long complementary feeding with FS does not have a significantly larger effect than LP on mean weight gain in all infants, but it is likely to boost linear growth in the most disadvantaged individuals and, hence, decrease the incidence of severe stunting

Understanding the challenges to caring for low birthweight babies in rural southern Malawi: a qualitative study exploring caregiver and health worker perceptions and experiences

Low birthweight (LBW) babies account for >80% of neonatal mortality in sub-Saharan Africa and South Asia and those who survive the neonatal period are still at risk of detrimental outcomes. LBW is a major public health problem in Malawi and strongly contributes to the country's high neonatal mortality rate. We aimed to get a better understanding of the care of LBW babies in rural Malawi in order to inform action to improve their outcomes. Qualitative methods were used to identify challenges faced by caregivers and health workers within communities and at the rural facility level. We conducted 33 in-depth interviews (18 with caregivers; 15 with health workers) and 4 focus group discussions with caregivers. Interviews were recorded, transcribed and translated. Thematic analysis was used to index the data into themes and develop a robust analytical framework. Caregivers referred to LBW babies as weak, with poor health, stunted growth, developmental problems and lack of intelligence. Poor nutrition of the mother and illnesses during pregnancy were perceived to be important causes of LBW. Discrimination and stigma were described as a major challenge faced by carers of LBW babies. Problems related to feeding and the high burden of care were seen as another major challenge. Health workers described a lack of resources in health facilities, lack of adherence to counselling provided to carers and difficulties with continuity of care and follow-up in the community. This study highlights that care of LBW babies in rural Malawi is compromised both at community and rural facility level with poverty and existing community perceptions constituting the main challenges. To make progress in reducing neonatal mortality and promoting better outcomes, we must develop integrated community-based care packages, improve care at facility level and strengthen the links between them

Prevention and treatment of childhood malnutrition in rural Malawi: Lungwena nutrition studies

Malawi is one of the poorest countries in the world with poor health and nutritional indicators. It is sometimes only surpassed by countries under conflict. Such a situation necessitated a search for local causes of undernutrition which heavily contribute to childhood mortality in Malawi.Literature showed that certain aspects of undernutrition had not been wholly explained. The determination of when growth faltering starts had been hampered by lack of an appropriate reference standard. This raised a question when growth faltering actually start, as preventive strategies had to be instituted early in the development of the problem. Forthis, local studies were needed. The review highlighted the fact that determinants of malnutrition may not have the same importance in all settings and thus preventive strategies that work in one place may not work in all settings. This meant that determination of local causes and effective interventions was one way of alleviating the problem. It had been standard to consider underweight and stunting as being resultantfrom the same causal factors. The epidemiology of wasting and stunting and the relationship of weight and height gain suggested possible difference in aetiology and a need to develop a clear understanding of their relationship, which in turn could help in developing effective interventions

Drivers of food consumption among overweight mother-child dyads in Malawi

To address the increase in overweight and obesity among mothers and children in sub-Saharan Africa, an understanding of the factors that drive their food consumption is needed. We hypothesized food consumption in Malawi is driven by a combination of factors, including season, food accessibility (area of residence, convenience of purchasing food, female autonomy), food affordability (household resources, food expenditures, household food insecurity), food desirability (taste preferences, body size preferences), demographics, and morbidity. Participants in Lilongwe and Kasungu Districts were enrolled across three types of mother-child dyads: either the mother (n = 120), child (n = 80), or both (n = 74) were overweight. Seven-day dietary intake was assessed using a quantitative food frequency questionnaire during the dry and rainy seasons. Drivers associated with intake of calories, macronutrients, and 11 food groups at p<0.1 in univariate models were entered into separate multivariate linear regression models for each dietary intake outcome. Mother-child dyads with an overweight child had a higher percent of calories from carbohydrates and lower percent of calories from fat compared to dyads with a normal weight child (both p<0.01). These mothers also had the highest intake of grains (p<0.01) and their children had the lowest intake of oil/fat (p = 0.01). Household food insecurity, maternal taste preferences, and maternal body size preferences were the most consistent predictors of food group consumption. Household food insecurity was associated with lower intake of grains, fruits, meat and eggs, oil/fat, and snacks. Maternal taste preferences predicted increased consumption of grains, legumes/nuts, vegetables, fish, and oil/fat. Maternal body size preferences for herself and her child were associated with consumption of grains, legumes/nuts, dairy, and sweets. Predictors of food consumption varied by season, across food groups, and for mothers and children. In conclusion, indicators of food affordability and desirability were the most common predictors of food consumption among overweight mother-child dyads in Malawi

Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi.

Serum zinc concentration (SZC) is used widely to assess population-level zinc status. Its concentration decreases during inflammatory responses, which can affect the interpretation of the results. This study aimed to re-estimate the prevalence of zinc deficiency in Malawi based on the 2015-2016 Malawi Micronutrient Survey (MNS) data, by adjusting SZC measures with markers of inflammation. SZC and inflammation data from 2760 participants were analysed. Adjustments were made using: (1) The Internal Correction Factor (ICF) method which used geometric means, and (2) The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) method, which used linear regression. Mean SZC values increased significantly when adjustments were made by either ICF or BRINDA (p < 0.001). The national prevalence of zinc deficiency decreased from 62% to 59%, after ICF adjustment, and to 52% after BRINDA adjustment. ICF and BRINDA values of SZC were highly correlated (p < 0.001, r = 0.99), but a Bland-Altman plot showed a lack of agreement between the two methods (bias of 2.07 µg/dL). There was no association between the adjusted SZC and stunting, which is a proxy indicator for zinc deficiency. Inflammation adjustment of SZC, using ICF or BRINDA, produces lower estimates of zinc deficiency prevalence, but the lack of agreement between the adjustment methods warrants further research. Furthermore, the lack of association between SZC and stunting highlights the need to explore other biomarkers and proxies of population zinc assessment. This study demonstrates the importance of considering inflammatory confounders when reporting SZC, to ensure accuracy and to support policy decision making

Intra-household use and acceptability of Ready-to-Use-Supplementary-Foods distributed in Niger between July and December 2010.

Few studies have looked at consumption of Ready-to-Use-Supplementary-Foods (RUSFs) during a nutritional emergency. Here, we describe the use and acceptability of RUSF within households in four districts of the region of Maradi, Niger during large scale preventive distributions with RUSF in 2010 targeted at children 6-35months of age. Our study comprised both quantitative and qualitative components to collect detailed information and to allow in-depth interviews. We performed a cross-sectional survey in 16 villages between two monthly distributions of RUSF (October-November 2010). All households with at least one child who received RUSF were included and a total of 1842 caregivers were interviewed using a structured questionnaire. Focus groups and individual interviews of 128 caregivers were conducted in eight of the selected villages. On average, 24.7% of households reported any sharing of RUSF within the household. Sharing practices outside the household remained rare. Most of the sharing reported occurred among children under 5years of age living in the household. On average, 91% of caregivers in all districts rated the child's appreciation of the products as good or very good. Program planning may need to explicitly accounting for the sharing of products among children under 5 within household