Children require nutritionally adequate foods for optimal growth and development.
In developing countries, most of the complementary foods offered to children are
inadequate in quality and quantity leading to the development of undernutrition.
Child undernutrition is associated with morbidity and mortality and as such poses a
major public health problem.
Supplementary feeding is one of the effective ways of meeting the nutrient gap left
by the poor complementary food. Even though supplementary feeding of children
with high energy density food results in higher weight gain, it has also been shown
to displace breast milk and the regular diet. Therefore, there is need to identify an
effective supplementary food that improves weight and provides adequate energy
and micronutrients with minimal risk of displacing breast milk and the regular diet.
As such, this present research work was conducted in two trials and two studies
namely the efficacy trial, effectiveness trial, breast milk study and dietary intake study.
All these are referred to as studies in this thesis. These studies took place at 7 health
facilities in Mangochi district in Malawi, South East Africa.
The efficacy study (I) was conducted in a controlled setting to determine whether
supplementation of moderately underweight children with lipid based nutrient
supplements (LNS) or corn-soy blend (CSB) improves weight gain. Total of 192
underweight children aged 6-15 months received for 12 weeks a daily portion of 43
g LNS or 71 g CSB, which provided 220kcal and 284kcal, respectively, or no
supplementation (control). These supplements were provided at the participants’
homes weekly for 12 weeks. The primary outcome was weight change. At the end of
the 12-week supplementation period, the LNS but not CSB group gained more
weight compared to the control group. Higher weight gains were observed among
the most undernourished participants.
The effectiveness study (II) was carried out to determine if supplementation of
moderately underweight children with CSB or LNS through the National Health
Service could improve weight gain. The participants’ guardians collected the
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supplements from the health facility every four weeks for 12 weeks. A total of 299,
6-15 month-old children received on average 43g LNS or 71g CSB daily, providing
220kcal and 284kcal, respectively, or no supplement (control) for 12 weeks. Main
outcome was weight gain. Compared to no supplementation, a modest gain in weight
was associated with LNS supplementation and not CSB supplementation.
The breast milk study (III) was conducted to test the hypothesis that provision of
LNS to Malawian infants would not decrease their breast milk intake more than a
provision of CSB. A total of 44 mother-infant pairs took part. The infants received
a daily ration of 25 g LNS, 50 g LNS, or 72 g CSB that provided 127 kcal, 256 kcal
and 282 kcal respectively. The primary outcome was the difference in the quantity
of breast milk intake after one month of complementary feeding. After one month
of complementary feeding, breast milk intake in all the three groups reduced
significantly but were comparable in all groups. The results suggested that
complementary feeding of Malawian infants with LNS and CSB have similar effects
on breast milk intake.
The dietary intake study (IV) assessed the effect of supplementation of CSB or LNS
on energy and nutrient intake from the regular complementary foods to moderately
underweight children. A structured interactive 24-hour recall method was used to
collect data on intake of the regular complementary foods from 188 children aged
between 8 and 18 months and participating in study I. Intakes were estimated and
compared between the unsupplemented (control) group and the intervention groups
(CSB and LNS). In this trial, LNS supplementation was associated with significantly
higher energy and protein intakes. CSB supplementation was associated with higher
but not significantly increased intakes of energy and proteins. Both CSB and LNS
led to higher intakes of micronutrients (calcium, iron, zinc, and Vitamin C).
In conclusion, these studies show that LNS supplementation to children improves
weight gain and leads to higher intakes of energy and nutrient from the regular
complementary foods than CSB supplementation. A similar effect on intake of
breast milk is observed with supplementation of either LNS or CSB