Impact of spirulina corn soya blend on protein energy malnourished and iron deficient children aged 6-23 months in Ndhiwa sub-county-Kenya.
Othoo, Dorothy Apondi
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Protein Energy Malnutrition (PEM) and iron deficiency Anemia (IDA) affect children below five years globally. Studies in Kenya show levels of stunting (26%), wasting (4%), underweight (11%) and low iron intakes (7%) among children aged 6-23 months. These children are at critical period of rapid growth marked by malnutrition which can be irreversible if not effectively addressed. The standard CSB to manage PEM is inadequate in energy and micronutrients. Spirulina powder is richer in proteins and iron than soya bean and if used to fortify CSB would provide a more energy dense and iron rich flour than standard CSB. The SCSB can be produced locally by households to ensure nutritious consumption for under-nourished children than CSB. The objective of the study was to determine impact of SCSB on PEM and IDA among children aged 6-23 months in Ndhiwa Sub-County through a randomized controlled trial. A total of 240 children with PEM and IDA were accessed at Ndhiwa Sub-County Hospital and randomly assigned to two experimental groups (EG1 received SCSB while EG2 received standard CSB) and one control group who did not receive any treatment during the intervention. Data was collected using a questionnaire and a Focus Group Discussion (FGD) guide. PEM was assessed using the following indicators; plasma Retinol Binding Protein, WHZ and WAZ scores while iron status assessed based on Hematocrit levels. Relative Risk, Difference in Difference and Log-rank tests were used to compare impact of SCSB and standard CSB on PEM and IDA while logistic regression used to identify predictors of plasma RBP, Hct levels, WHZ and WAZ. At baseline, assessment of plasma RBP and Hct levels was done. In addition nutrient content analysis of spirulina powder, SCSB, CSB and maize flours was done for carbohydrates, proteins, fats and iron, and production of SCSB and CSB flours used in the intervention. Intervention was done for 6 months and involved daily consumption of 100g SCSB and CSB flours while doing assessments of key variables up to six months. The SCSB was significantly higher in energy (5.4±0.1Kcal/100g vs 2.9±0.7 and 2.8±0.3, p=0.036), protein (20.84±0.2 vs 15.47±0.2 and 0.06±0.1, p=0.043) and iron (15.32±0.2 vs 6.15±0.3 and 0.81±0.2, p=0.043) than CSB and maize meal. The children who consumed SCSB significantly improved in RBP status (RR:3.07;CI:2.62-2.72,p=0.004 and RR:4.06;CI:3.63-3.76,p=0.0001), Hct status (RR: 3.15;CI:1.91-2.07,p=0.002 and RR:4.07;CI:3.66-3.79,p<0.0001), wasting (RR:3.10;CI:0.001-0.48,p=0.0001 and RR:4.08;CI:3.37-3.58,p=0.0001) and underweight (RR: 3.16;CI:3.58-3.91,p=0.0001 and RR:4.18;CI:3.05-3.27,p=0.0001) compared to children who consumed CSB and those in control group. The children who consumed SCSB had faster recovery from PEM and IDA compared to children who consumed CSB and children in control group. The breast fed children consuming SCSB were significantly meeting RDAs for energy (913.8±149Kcal vs 727.8±125 and 654±114,p=0.011 ), protein (15.2±8g vs 8.9±3 and 8.2±2, p=0.004) and iron (15.9±0.3mg vs 6.0±0.7 and 4.3±0.8, p=0.004) as well as non-breastfed; energy (832±116Kcal vs 781±93 and 652±102, p=0.022), protein (19.9±8 vs 8.3±3 and 6.2±4, p=0.001) and iron (15.9±0.1 vs 7.1±0.2 and 4.9±0.6, p=0.002) compared to children who consumed CSB and those in control group. There were no significant difference in the acceptability attributes of mothers/caregivers of children who consumed both SCSB and CSB porridges (chisquare: p>0.005). The SCSB had a significantly higher impact on PEM and iron deficiency than standard CSB and control group. The use of spirulina powder as a fortifier for commonly consumed cereals in Kenyan communities is recommended.