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

doi:10.1093/ajcn/nqz163

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

Am J Clin Nutr. 2019 Oct 1;110(4):1026-1033. doi: 10.1093/ajcn/nqz163.

Authors

Christine P Stewart¹, Bess Caswell¹, Lora Iannotti², Chessa Lutter³, Charles D Arnold¹, Raphael Chipatala⁴, Elizabeth L Prado¹, Kenneth Maleta⁴

Affiliations

¹ Department of Nutrition, University of California, Davis, CA, USA.
² Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA.
³ RTI International, Washington DC, School of Public Health, University of Maryland, College Park, MD, USA.
⁴ School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diet*
Eggs*
Female
Humans
Infant
Infant Nutritional Physiological Phenomena
Malawi
Male
Mothers
Nutritional Status*
Young Adult

Associated data

ClinicalTrials.gov/NCT03385252

Grants and funding

P30 DK056341/DK/NIDDK NIH HHS/United States