Complementary feeding practices and dietary intakes from complementary foods amongst weanlings in rural Malawi

Abstract

Objective: The objectives of this study were to estimate the quantity and nutritive quality of the complementary diet in rural Malawi, and to identify feeding practices, nutrients and dietary modifiers of iron and zinc bioavailability that may limit the quality of the diet. Design: This cross-sectional study design included an anthropometric survey, a feeding practices questionnaire, and an interactive, 24 h recall dietary data survey. Setting: Four rural villages in Balaka district, southern Malawi. Subjects: Mothers resident in the study communities with breastfed children aged up to 24 months were eligible. Results: Stunting was prevalent among these weanlings. Maize was the predominant food source, with limited contribution of animal foods. Deficits in dietary energy and several nutrients were found when compared to estimated needs. When expressed per kg body weight, energy intakes appeared adequate. The bioavailability of zinc was low due to a high phytate:zinc molar ratio. Iron bioavailability was also low due to low intake of absorption enhancers such as meat=fish=poultry protein and ascorbic acid. Dietary quality was poorest for 6 to 8-month-old infants. Conclusions: Iron, zinc and calcium were the most limiting nutrients to the quality of the diet, partly exacerbated by the poor bioavailability of iron and zinc. Increased total intake and bioavailability of iron and zinc would improve the complementary diets.

Participatory nutrition education and adoption of new feeding practices are associated with improved adequacy of complementary diets among rural Malawian children: a pilot study

“…A modest increase in the intake of iron, zinc, and energy equivalent to 20% of estimated needs from complementary foods for children 9 to 23 months of age was judged to be a reasonable increase from such an intervention. A total sample size of 18, 59, and 101 children would be necessary to achieve statistically significant differences between control and intervention groups for intakes of iron, zinc, and energy, respectively, with 80% power, a ¼ 0.05, and a ratio of control to intervention subjects of 0.6; variability of iron, zinc, and energy intakes used in these calculations was derived from an earlier study of complementary-fed children from this same population (Hotz & Gibson, 2001a). A lower ratio of control subjects was planned given that collection of assessment data in control communities can be more difficult than in communities where interventions are given.…”

“…The lessons also took into account specific needs of the population based on an earlier assessment in the same communities (Hotz & Gibson, 2001a). Five experienced field staff members were trained extensively in general nutrition and specific details of the nutrition messages.…”

“…Increasing the energy density of porridges: The concept of 'energy' was discussed, explaining to mothers that one way to better feed children is to offer foods that contain more energy. For early infant feeding in Malawi, a thin, watery maize flour porridge (light phala; 7% maize flour; 105 kJ per 100 g) is commonly used instead of the thicker version (hard phala; 10% maize flour; 151 kJ per 100 g) used later (Hotz & Gibson, 2001a). During the lesson, it was explained that one cup of hard phala contains more energy than one cup of light phala, as more flour is used to prepare it.…”

“…Methods to increase the intake of bioavailable iron and zinc: Two methods to increase the amount of bioavailable iron and zinc from maize flour were introduced. The lesson stressed the absence of adequate sources of iron and zinc in the traditional diet (Hotz & Gibson, 2001a) and on the importance of these two micronutrients for optimal health and development. Meat, fish, and poultry were noted as very good sources of these two micronutrients that should be incorporated into the complementary diet whenever possible.…”

The effect of traditional malting technology practiced by an ethnic community in northern Uganda on in‐vitro nutrient bioavailability and consumer sensory preference for locally formulated complementary food formulae

“…Such food resources can be compounded in appropriate proportions to make nutritious composite formulae. However, it is important to recognize that in rural areas in Sub‐Saharan Africa, food resources available are mainly plant‐based (Hotz & Gibson, 2001). Therefore, complementary foods made locally in rural settings are largely of plant origin.…”