The effect of eggs on early child growth in rural Malawi: the Mazira Project randomized controlled trial

Abstract

Background Stunted growth is a significant public health problem in many low-income countries. Objective The aim of this study was to evaluate the impact of 1 egg per day on child growth in rural Malawi. Design We conducted an individually randomized controlled trial in which 660 children aged 6–9 mo were equally allocated into an intervention (1 egg/d) or control group. Eggs were provided during twice-weekly home visits for 6 mo. Control households were visited at the same frequency. Assessors blinded to intervention group measured length, weight, head circumference, and midupper arm circumference at baseline and the 6-mo follow-up visit. To assess adherence, multipass 24-h dietary recalls were administered at baseline, 3-mo, and 6-mo visits. Results Between February and July 2018, 660 children were randomly assigned into the intervention (n = 331) and control (n = 329) groups. Losses to follow-up totaled 10%. In the intervention group, egg consumption increased from 3.9% at baseline to 84.5% and 70.3% at the 3-mo and 6-mo visits, whereas in the control group, it remained below 8% at all study visits. The baseline prevalence of stunting was 14%, underweight was 8%, and wasting was 1% and did not differ by group. There was no intervention effect on length-for-age, weight-for-age, or weight-for-length z scores. There was a significantly higher head circumference for age z score of 0.18 (95% CI: 0.01, 0.34) in the egg group compared with the control group. There was a significant interaction with maternal education (P = 0.024), with an effect on length-for-age z score only among children whose mothers had higher education. Conclusions The provision of 1 egg per day to children in rural Malawi had no overall effect on linear growth. A background diet rich in animal source foods and low prevalence of stunting at baseline may have limited the potential impact. This trial was registered at clinicaltrials.gov as NCT03385252.

Early Child Development Outcomes of a Randomized Trial Providing 1 Egg Per Day to Children Age 6 to 15 Months in Malawi

“…Among effect modifiers, we found a consistent pattern that subgroups of children who were less vulnerable at baseline tended to show positive effects of the intervention, for example, those with higher initial LAZ, mild to no food insecurity, higher household wealth, and higher maternal education. A similar pattern was found for the main outcome of the trial, that is a positive effect of the intervention on LAZ among children of mothers with higher maternal formal education ( 5 ). Thus, although the primary analyses did not reveal robust effects of the intervention, it is possible that the intervention is effective for this population under some conditions.…”

“…One potential explanation for the lack of overall effects of the intervention on child development was that adherence to egg consumption may have been low, especially among more vulnerable children. However, multipass 24-h dietary recalls administered at the baseline, 3-mo, and 6-mo visits suggested that adherence was relatively high ( 5 ). According to these recalls, at baseline, only 4% of children consumed eggs on the previous day.…”

“…Eligible children were those aged 6–9 mo residing in the catchment areas of the Lungwena Health Center and St. Martins Hospital of Malindi. Details of recruitment and inclusion criteria have been published previously ( 5 ). All protocols were reviewed and approved by the Institutional Review Boards at the University of California, Davis, and the College of Medicine in Malawi.…”

“…A second objective was to determine whether egg consumption positively affects child development. Analysis of the growth outcomes revealed a significant positive effect on head circumference z-score (HCZ), but no effect on length-for-age z-score (LAZ) or other growth outcomes ( 5 ). Here, we report the developmental outcomes of the Mazira Project.…”

Young Children Who Eat Animal Sourced Foods Grow Less Stunted: Findings of Contemporaneous and Lagged Analyses from Nepal, Uganda and Bangladesh

“…Association between LAZ or stunting in children(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months of age) and contemporaneous ASF consumptionThe table reports estimation results using FE panel regressions. The outcome variable in Panel A is child's LAZ and a dummy variable equal to 1 if the child is stunted in Panel B.Co-variates and control variables: child consumed starchy staples, dark green leafy vegetables, vitamin A rich fruits and vegetables, other fruits and vegetables, legumes, nuts and seeds, child's age, age squared, age cube, a dummy variable equal to 1 if the child is a girl, a dummy variable equal 1 if the child had diarrhea in the past two weeks, the caregiver's years of education, the mothers height, a dummy equal to 1 if the household has an improved latrine.…”