| dc.description.abstract | Background: Infant growth faltering is usually associated with an increased risk of
morbidity and mortality. It is common in resource limited settings and constrains infants’ full
development resulting in reduced physical capacity and overall productivity later in life.
Major causes are inappropriate feeding practices and poor quality complementary foods with
low energy density and micronutrients deficiency. Interventions to improve the quality of
complementary foods exist like use of fortified blends among others but with mixed
results/outcomes. Among the interventions is also the use of animal source foods (ASFs) to
improve the quality of the blends. With increasing attention to ASFs and especially those that
are locally available, easily accessible, cheaper and acceptable in the localities, the effects of
the same on infant nutrition, growth and development need special attention. The impact of
incorporating indigenous nutrient rich and relatively cheap, locally available and readily
acceptable but underutilized/neglected ASFs such as edible termites and dagaa small fish and
micronutrient fortification of complementary foods on growth of infants from resource
limited settings has been inadequately studied.
Objectives: To test the acceptability and efficacy of improved complementary food blends
named WINFOOD Classic ((WFC)- with 10% edible termites, 3% dagaa small fish and
germinated grain amaranth), WINFOOD Lite ((WFL)-with germinated grain amaranth
fortified with micronutrients at the rate of Corn Soy Blend Plus (CSB+)) and CSB+ (Corn
and Soya fortified with micronutrients) on growth (measured as length and weight gain),
haemoglobin concentration, anaemia prevalence and iron status of infants 6 to 15 months
from a resource limited rural setting in Kakamega County, Western Kenya.
Study implementation: Three-stage study comprising assessment of: 1) acceptability of
improved-animal source foods enhanced-fortified complementary blends 2) prevalence of
malnutrition in the study population among infants 6-23 months and, 3) the effect of the
complementary foods on linear growth and weight gain, haemoglobin concentration, anaemia
prevalence and iron status among infants 6 -15 months of age in a randomized controlled trial
(RCT).
Design: The acceptability study was a cross over design study with wash out periods while
the nutitional status styd prior to the intervetin study was determined using a cross section
design. The intervention study was a community-based double blind randomized trial in
which infants were individually randomized at 6 months of age to receive one of the three
study complementary foods: WFC, WFL and CSB+ for 9 months.
Methods: Acceptability to mothers and infants of the improved-ASFs enhanced and fortified
complementary blends WFC, WFL or CSB+ porridge recipes was assessed prior to the
industrial production of the blends among fifty seven (57) infant-caregivers dyads.
A cross sectional anthropometric, dietary and morbidity data among six hundred and eighteen
(618) infants and young children aged 6-23 months old was also collected prior to the
randomized controlled trial (RCT).
In the intervention study, Four hundred and ninety nine (499) infants were randomized to
receive WFC (n= 165), WFL (n= 167) or CSB+ (n=167) from 6–15 months of age. The
primary outcome was linear growth while secondary outcomes included weight gain,
haemoglobin concentration, iron status (determined as ferritin and soluble transferrin receptorcells), reported morbidity and serum concentration of acute phase reactants. Anthropometric
measurements were taken monthly. Dietary intake and morbidity were determined by mother
reported monthly recall. Haemoglobin concentration and iron status and related biomarkers
were also assessed at baseline (6 months) and endline (15 months).
Results: The acceptability study showed that all the three foods (WFC, WFL and CSB+)
were acceptable to the study population with no adverse effects.
The cross section study to help interpret the results of the intervention study showed that
malnutrition was highly prevalent. Despite high breastfeeding rates of about 83%,
complementary feeding was introduced earlier than recommended at an average age of 3.8
(SD 0.3) months. The prevalence of stunting (Z-scores for height-for-age [HAZ] <−2),
wasting (Z-scores for weight-for-height [WHZ] <−2) and underweight (Z-scores for weightfor-
age [WAZ] <−2) was 35.7%, 4.1%, and 13.4%, respectively in the study population.
The intervention study revealed a mean length gain from 6 to 15 months of 9.5 (SD 2.4)
cm, 9.8 (SD 2.0) cm and 9.7(SD 2.2) cm for infants in the WFC, CSB+ and WFL groups
respectively (p = 0.39). The mean weight gain between 6 and 15 months was 2.0 (SD 0.8) kg,
2.2 (SD 0.7) kg and 2.2 (SD 0.7) kg for infants in the WFC, CSB+ and WFL groups
respectively (p=0.35). Infants in WFC, CSB+ and WFL had significantly higher haemoglobin
concentration (p < 0.001) at 15 months compared to haemoglobin concentration at 6 months
[-0.3(SD1.8) g/dl, 0.6 (SD 1.6) g/dl and 0.2(SD 2.0) g/dl respectively].
The mean transferin receptors were significantly different between 6 and 15 months: 1.9
(SD 5.2), -1.4 (SD 3.5) and 0.3 (SD 3.6) (mg/l) (p<0.001) for WFC, CSB+ and WFL
respectively. The iron body stores (mg/kg body weight) at 15 months was also significantly
different from those at six months: -2.5 (SD 4.2), -0.7 (SD 3.8) and -1.7 (SD 4.0) (p=0.001)
for WFC, CSB+ and WFL respectively.
The daily energy intake from traditional complementary foods for infants 6-8, 9-11
months and young children ≥12 months old was 1.6±0.7, 2.4±0.5 and 2.2±0.5 (MJ/day)
respectively while the Infants 6-8, 9-11 and ≥ 12 months consumed about 60g, 142g and
150g respectively. The daily iron, calcium and zinc intake from the complementary foods
was 0.4±0.2 mg, 130.0±90.0mg and 2.0±0.6 mg respectively.
Throughout the 9 months study period and across the food groups, the infants were
well/alert and the caregivers reported no major symptoms of disease except for coughing,
audible wheezing and running nose (76.3%, 61% and 80.5% respectively) which were
significantly different across all the food groups in the first 2 months of the study (p=0.02,
0.01 and 0.01 respectively).
Conclusion: All the foods were acceptable with no adverse effects. The prevalence of
malnutrition in the study area was high. The complementary food blends had a similar effect
on infant and young children growth (weight and length gain) but had significant
improvement in haemoglobin concentration, body iron stores and transferrin receptors. These
blends may therefore be used to improve the micronutrient status and health of infants in
resource limited settings. More research to investigate the bioavailability mechanisms of the
nutrients from the edible termites is however needed to help create evidence based and
enabling policy environment to support the use of the edible insects in related intervetions | en_US |
