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Research highlights
In this section, the IYCN Project offers summaries of new and notable research related to maternal, infant, and young child nutrition. Each summary includes the findings and analysis of the study’s author(s) only. Check back periodically for new research highlights.
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Can current food aid commodity formulations meet energy needs for kids?
May 2009
Corn-soy blend, wheat-soy blend, and corn-soy milk are three commodities commonly distributed by the US Agency for International Development for use as complementary foods for infants 6–24 months of age. While the World Health Organization recommends that complementary foods contain an energy density of at least 0.8 kcal/g to meet the daily requirements of a 6–8-month-old infant with average breast milk intake consuming two meals/day, the authors of a study in the International Journal of Food Sciences and Nutrition found that achieving adequate energy density with those food aid commodities would require a 20 percent concentration of flour in prepared porridge, which results in a porridge that is too viscous for consumption by an infant. Porridge prepared at 12 percent concentration yielded a more typical porridge but contained only 0.5 kcal/g. Adding dried milk to the flours would reduce viscosity but drive up cost significantly, while adding oil after cooking to reduce viscosity would improve energy density but require reformulation of the commodities to ensure adequate protein and micronutrient consumption. The authors call for new commodity formulations and specifications in order to enable food programs to have an impact on infant nutrition. While the authors do not specifically mention it, the findings also emphasize that common “one size fits all” recommendations for meal frequency and volume can be inappropriate for the type of complementary foods that caregivers use.
Does early breastfeeding cessation for mothers with low CD4 counts increase infant mortality?
April 2009
Evidence shows that HIV-exposed, uninfected infants are at greater risk of illness and death than unexposed infants, and that low maternal CD4 count is associated with even greater risk of infant death. However, the cause of this association is not fully understood. In a recent study published by the International Journal of Epidemiology, investigators in Zambia tested the hypothesis that earlier breastfeeding cessation among women with low CD4 counts is responsible for some of the increased infant mortality risk. This study confirmed that both CD4 count and early breastfeeding cessation were associated with increased infant mortality, but that only a small percentage of the association between low CD4 count and high mortality could be attributed to early breastfeeding cessation. Other potential factors requiring investigation include exposure to infectious diseases, low birth weight, poor growth, and poor caring practices. Nonetheless, the authors concluded that some portion of infant deaths could be averted by increased breastfeeding duration among mothers with low CD4 counts.
Flexible administration of sprinkles for anemia control improves adherence and impact
February 2009
Liquid iron supplements have done little to reduce high rates of iron deficiency anemia among young children in developing countries, largely due to poor adherence. Studies have shown that home fortification of regularly consumed complementary foods with micronutrient powders like Sprinkles can improve hemoglobin concentrations. In a trial in Bangladesh, recently published in the European Journal of Clinical Nutrition, authors hypothesized that intermittent and flexible supplementation with Sprinkles might improve acceptability and adherence compared to daily supplementation. Children ages 6–23 months in three intervention groups received 60 sachets of Sprinkles to use either daily for two months, over three months as desired, or over four months as desired. Children in the flexible four-month group had the best adherence, consuming 98 percent of provided Sprinkles packets, and had higher average hemoglobin concentrations at the end of the trial. Six months after the intervention, only children in the flexible groups maintained the improved hemoglobin status. Mothers in those groups said flexible administration was easier to adopt, and the authors concluded that the autonomy to decide when to use Sprinkles was a motivator to improve adherence, which ultimately resulted in better outcomes.
Benefits of daily nutritional supplements for children in Malawi
January 2009
In a study published in the American Journal of Clinical Nutrition, three groups of Malawian children received daily supplementation of either 71 grams of corn-soy flour that required cooking, and either 50 grams or 25 grams of a ready-to-eat fortified spread (FS) made of peanut paste, milk powder, vegetable oil, sugar, and a micronutrient mixture. Rations were provided from the ages of 6 to 18 months, and growth outcomes were tracked for 36 months. Two years after the intervention, severe stunting rates were 19.6 percent in the corn-soy flour group, 3.6 percent in the FS50 group, and 10.3 percent in the FS25 group. The FS50 group experienced the greatest improvements, and the FS25 group the least, in weight, height, mid-upper-arm circumference, and head circumference. The authors hypothesize that the larger portion of milk powder in the FS50 may have contributed to the timing of growth acceleration and subsequent growth outcomes. The cost of FS50 was approximately 20 cents per day, or $72 per child for 12 months.
Iron supplementation for HIV-positive children: health benefit or harm?
January 2009
Anemia is common among HIV-positive children and has been associated with rapid disease progression and risk of death. While anemia has many causes, iron deficiency also commonly occurs in areas with a high HIV burden, and HIV-positive children may be targeted by routine iron supplementation programs. Because iron supplementation is potentially dangerous during other infections, like malaria, a Cochrane review examined available evidence on the impact of the intervention on health outcomes of HIV-positive children. The authors did not find any randomized controlled trials—only observational studies and opinions. The authors concluded that there is an urgent need for randomized controlled trials to determine whether iron supplementation is beneficial or harmful for HIV-infected children.
Iron supplementation for reducing morbidity and mortality in children with HIV
How do World Health Organization growth standards impact programs?
January 2009
A recent article in Pediatrics revealed how program enrollment and infant health outcomes would have changed if the 2006 World Health Organization (WHO) growth standards had been used to identify severely acutely malnourished children in a Médecins Sans Frontières feeding program. Researchers conducted a retrospective analysis of data on moderately and severely acutely malnourished children from 6 to 59 months of age in Niger in 2006. They identified eight times as many severely malnourished children using the 2006 WHO z-score cut-off (<-3 z-scores) compared to the National Center for Health Statistics (NCHS) cut-off (<70% of the median). This difference in prevalence was much greater than the difference identified in other, similar studies. Children identified by the WHO standards who would not have met the NCHS cut-off point were younger, had higher weight-for-age z-scores at admission and discharge, required fewer days of treatment, and had better rates of recovery. According to the authors, the results indicate the need to further investigate how use of the WHO standards will impact the resources required for therapeutic feeding programs. Although standards may increase program enrollment, programs will save resources because of shorter treatment duration and decreased need for inpatient care, and patient outcomes will improve.
Formula feeding a dangerous option in rural Africa
December 2008
Results from a study in Rakai, Uganda, confirmed once again that promoting formula feeding for HIV-exposed infants can be dangerous in certain settings. In a program-based intervention in a mostly rural area, mothers received antenatal infant feeding counseling and chose exclusive breastfeeding or formula feeding. By 12 months, formula-fed infants had a 6 times greater risk of mortality compared to breastfed infants (18% vs. 3%). Despite very low adherence to exclusive breastfeeding, HIV-free survival was 96% among breastfed infants and only 86% among formula-fed infants (p=.16) at 12 months. The lack of significance may be due to a relatively small sample size. Even though the program provided free formula, utensils, and significant support, many mothers did not wash utensils before using them, gave formula in bottles, used unsafe drinking water, and had difficulty preparing formula in correct proportions. The authors concluded that programs should not promote formula feeding in rural Africa.
Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda
Including fathers in breastfeeding promotion
September 2008
A controlled clinical trial in Brazil assessed the impact of a hospital-based education program for fathers on breastfeeding practices at six months. Mothers or mother/father pairs participated in a breastfeeding education session, watched a video, and received a handout. A control group received no intervention. The intervention with only mothers increased breastfeeding duration, but including fathers with less than eight years of education reduced breastfeeding duration. Overall, the intervention with mothers and fathers increased exclusive breastfeeding prevalence, but only when fathers had more than eight years of education. The authors concluded that the negative impact of the intervention on breastfeeding duration when including fathers with less education may have been attributable to the video, which did not consider traditional male roles. The video’s focus on fathers helping with household chores so that the mothers could breastfeed may have not have been culturally appropriate.
Inclusion of fathers in an intervention to promote breastfeeding: impact on breastfeeding practices
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