Efficacy of Sorghum Peanut Blend in The Treatment of Moderate Acute Malnutrition in Children Aged 6 - 59 Months in Karamoja Sub-Region, Uganda
Moderate acute malnutrition (MAM) is estimated to affect 11% of children worldwide. In Sub-Saharan Africa, 239 million people are malnourished with 48 million of these being children. Karamoja region has the highest cases of acute malnutrition in Uganda. Corn Soya Blend Plus (CSB+) is the traditional treatment for moderate acute malnutrition (MAM) in children 6-59 months. CSB+ was introduced as a substitute for CSB but does not provide a sustainable treatment for moderate acute malnutrition (MAM) due to unavailability to local communities and its high cost. Despite the availability of local foods to constitute dietary supplements for children that are relatively cheaper than CSB+ and with greater potential to provide a more sustainable solution to treat MAM, they are not widely promoted. There is need therefore to formulate food supplements from locally grown foods and to test their efficacy in treating MAM among children 6-59 months of age. The study was conducted in Karamoja region, Northern Eastern Uganda. The study was conducted in two phases: phase I involved formulating a test food supplement from sorghum and peanut, mixed with honey and ghee (SPB) along with assessing its nutritional and anti- nutrient profile. Phase II comprised the intervention, in which the acceptability and efficacy of SPB versus CSB+ in treating MAM was tested. The sample size for efficacy study was 440 children, 220 for each study arms; SPB and CSB+. A randomised single-blind parallel cluster trial was conducted in which two health centres were assigned on a 1:1 ratio by computer to the two study groups. Each child received a daily ration of 269g of either SPB or CSB+ for a maximum period of 3 months. Anthropometric measurements were taken on a bi-weekly basis. The primary outcomes were the recovery rate and the mean length of stay in the programme before full recovery. Data was analysed using (SPSS version 17). Levels of macronutrients, CSB+ had significantly higher amounts of protein and carbohydrates whereas SPB had significantly higher amounts of fat and crude fibre. There was no significant difference in terms of energy content in SPB and CSB+. Proximate components, beta-carotene, iron, zinc, calcium, magnesium, phosphorus, potassium, manganese and sodium amounts were available in adequate amounts in both products. Vitamin A level was higher in CSB+ than SPB. Levels of anti- nutrients; condensed tannin, phytates, and trypsin inhibitors were significantly higher in SPB but were in amounts lower than the acceptable limits. Aflatoxins were also below the 20ppb upper limits by FDA. The two food supplements were acceptable to the study participants in terms of all the sensory attributes. The recovery rates were not significantly different (91.4%) in the SPB and 87.1% in the CSB+ group (Chi-square test; P=0.193). Duration of recovery was significantly shorter for CSB+ group; median 43 days compared to 57 days in the SPB (Kaplan-Meir Survival test). The recovery rate and the duration of stay in the programme for those children fed on CSB+ and those on SPB were all within the acceptable Sphere Standards 2004 (≥75% and ≤90 days) respectively. The cost of SPB was much lower than the CSB+ if transportation costs are considered. SPB has the potential to become a cost-effective, sustainable locally-available home-based food supplement for treatment of MAM in the study community and other similar circumstances.