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

Christine P Stewart, Bess Caswell, Lora Iannotti, Chessa Lutter, Charles D Arnold, Raphael Chipatala, Elizabeth L Prado, Kenneth Maleta, Christine P Stewart, Bess Caswell, Lora Iannotti, Chessa Lutter, Charles D Arnold, Raphael Chipatala, Elizabeth L Prado, Kenneth Maleta

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.

Keywords: Malawi; child growth; complementary feeding; eggs; stunting.

Copyright © American Society for Nutrition 2019.

Figures

FIGURE 1
FIGURE 1
Participant flow diagram. *Numbers are cumulative. MUAC, midupper arm circumference.
FIGURE 2
FIGURE 2
The effect of the egg intervention on length-for-age z score stratified on prespecified effect modifiers of interest. LAZ, length-for-age z score.

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Source: PubMed

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