Linking Fortification Compliance Metrics With Decision Making Needs: From Brand Level Data to Market Share Weighted Information

Abstract Objectives A fortification program can only be effective if (1) each brand producer complies with fortification standards (i.e., adequately fortified), and (2) the adequately fortified products are consumed by a large proportion of the population. We quantified fortification quality (extent to which levels of fortification align with food standards) of oil, salt and wheat flour products; and ascertained the degree of food brand penetration and market share in Tanzanian markets. Methods Food inspectors collected multiple samples of food products at the production and/or market and laboratory analysts quantified the micronutrient content. We compared the average content for each individual brand product to the national fortification standards considering lab measurement uncertainty and classified into one of 4 fortification status categories (not fortified, fortified below, according to, or above the fortification standard). To establish penetration and market share, we visited 1500 retail outlets across regions in Tanzania to ascertain brand product availability and sales volumes. We applied weights using the market share estimates to extrapolate the fortification quality of the food market volume in the country. Results Of the different brand products of salt (26), wheat flour (25), and oil (68) found in the market, samples were collected and micronutrient content analyzed in the main oil (30%), salt (62%), and wheat flour brand products (85%). While 12% of salt, 35% of wheat flour, and 22% of oil brand products were fortified above the fortification standard minimum, when weighted by their market share, these represent 90% of the salt, 86% of wheat flour, and only 2% of the oil market volume respectively. Conclusions Fortification compliance of brand products provides important data for industry and regulatory authorities to identify where corrective action is necessary. Health and development staff are concerned about the extent to which additional nutrients are delivered to the population to anticipate public health impact, for which adjustment using reliable market share data is key. Weighted brand data can help resource constrained regulatory staff prioritize monitoring and enforcement activities to industries/producers with greatest influence. Funding Sources Bill and Melinda Gates Foundation (BMGF).

Download Full-text

Harmonization of Maternal Nutrition Trials – Finding and Creating Similarities in Protocols and Outcomes

Current Developments in Nutrition ◽

10.1093/cdn/nzaa065_003 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1738-1738

Author(s):

Alison Gernand ◽

Yemane Berhane ◽

Nita Bhandari ◽

Ranadip Chowdhury ◽

Fyezah Jehan ◽

...

Keyword(s):

Data Analysis ◽

Gestational Age ◽

Maternal Nutrition ◽

Time Frame ◽

Protein Supplementation ◽

Fetal Biometry ◽

Funding Sources ◽

Biospecimen Collection ◽

Gates Foundation ◽

Meta Analyses

Abstract Objectives Public health and clinical recommendations should be based on results from multiple studies, however trials often have outcomes that are not defined in the same way. This project aims to harmonize selected protocols, outcome definitions, and data analysis across five randomized trials of antenatal balanced energy-protein supplementation being conducted in Burkina Faso, Ethiopia, India, Nepal, and Pakistan. Methods Harmonization efforts include a range of activities from reviewing detailed protocols, biospecimen collection plans, data dictionaries, and data analysis plans to proposing best practices and acceptable practices based on field limitations. Most studies have not begun or are early in enrollment, an ideal time frame to make changes. A two-day workshop of lead investigators, content experts and advisors will be held in late February, and harmonization activities will continue thereafter. Results All studies are examining anthropometry at birth as a primary outcome, however the timing of birth measurements (hours since birth) and types of measurements taken differ across trials. All studies are estimating gestational age by ultrasound measurements, but the gestational age at ultrasound differs (in part due to differences in timing of antenatal care by country) as well as the number of fetal biometry measures. Finally, stillbirth is a key outcome across trials, but initial definitions had slight differences that will now be harmonized. We are also able to add new, important maternal and child health outcomes to each trial that will have the same protocols from inception (e.g., microbiome). Conclusions Efforts thus far have resulted in communication between study investigators, consideration of improved protocols, and addition of new outcomes to collect across all sites. Further results are forthcoming after the February workshop, which will include documentation of how much definitions vary across studies and the challenges of standardization. We expect the harmonization process to improve overall reporting within each study and provide opportunities for better meta-analyses. Funding Sources The Bill and Melinda Gates Foundation.

Download Full-text

Nutritional Iron Deficiency and Malaria: Impact of a Public-Private Partnership

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_042 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 837-837

Author(s):

Patricia Haggerty ◽

Daniel Raiten

Keyword(s):

Iron Deficiency ◽

Public Private Partnership ◽

Lessons Learned ◽

The Novel ◽

Private Partnership ◽

Funding Sources ◽

Novel Approach ◽

Research Track ◽

Gates Foundation ◽

The Impact

Abstract Objectives Background: In 2007 the Bill and Melinda Gates Foundation (BMGF) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) collaborated to address concerns about the safety and efficacy of interventions to prevent and treat nutritional iron deficiency (NID) particularly in the context of malaria. The “Iron and Malaria Project” (IMP) addressed how iron might not be safe, iron assessment, and the value of interventions to address NID. This presentation will: Describe the novel approach used to achieve the IMP goals, describe the IMP accomplishments and impacts, and summarize lessons learned. Methods The IMP had: 1) Research Track: NICHD initiated 2 funding opportunity announcements resulting in 10 funded projects; 2) Translation Track: a) consultations with global stakeholders; b) risk: benefit analyses on the use of interventions to prevent and treat NID; c) a collaboration with the CDC to develop standards for a sTfR assay; d) the BOND project to harmonize the process for discovery, development and deployment of nutrient biomarkers; e) the INSPIRE project, a review of extant evidence on reciprocal relationships between nutrition and inflammation; and f) the BRINDA project, a collaboration with the CDC, GAIN, and WHO to study the impact of inflammation on interpretation of biomarkers of iron and other determinants of anemia and develop approaches to account for this interaction. Results Funded grants included 4 basic science projects exploring mechanisms to explain iron and malaria interactions and 6 clinical studies addressing various aspects of the iron malaria relationship. To date, 72 journal publications have resulted. Using the NIH Relative Citation Ratio metric, 2/3 have scientific influence scores ≥the 50th percentile of all NIH-funded research publications and 15 have scores ≥ the 90th percentile. Conclusions The IMP leveraged the attributes of this public-private partnership between BMGF and NICHD/NIH to accomplish its goals. The partnership's complementarity and synergy resulted in broad traction and collaboration with a global community invested in solving the challenges of iron and malaria. Funding Sources BMGF $9.3 million, NIH Office of Dietary Supplements $1.3 million.

Download Full-text

Assessing the Coverage of Biofortified Foods: Development and Testing of Methods and Indicators in Musanze, Rwanda

Current Developments in Nutrition ◽

10.1093/cdn/nzaa067_060 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1833-1833

Author(s):

Nicolai Petry ◽

James Wirth ◽

Valerie Friesen ◽

Fabian Rohner ◽

Arcade Nkundineza ◽

...

Keyword(s):

Urban Areas ◽

Large Scale ◽

Household Survey ◽

Test Methods ◽

Food Fortification ◽

Program Performance ◽

Sweet Potatoes ◽

Cross Sectional ◽

Funding Sources ◽

Gates Foundation

Abstract Objectives Biofortification is a promising approach to increase micronutrient intakes, especially among populations that are hard to reach with other interventions. Information on the coverage of biofortified foods is needed to ascertain potential for impact, understand program performance, and identify bottlenecks. In this study, we aimed to develop and test methods and indicators for assessing household coverage of biofortified foods. Methods We developed five recall-based indicators of household coverage to assess biofortification programs building on approaches previously used to assess targeted and large-scale food fortification programs. These were: 1) consumption of the food; 2) awareness of the biofortified food; 3) availability of the biofortified food; 4) consumption of the biofortified food (ever); and 5) consumption of the biofortified food (current). We tested these indicators in a cross-sectional, cluster, household survey in 20 rural and five peri-urban areas in Musanze, Rwanda where two biofortification programs, i.e., biofortified beans and orange fleshed sweet potatoes (OFSP), were implemented. Results Among the 242 households surveyed, consumption of beans and sweet potatoes was high (99% and 96%, respectively) while awareness of biofortified beans or OFSP was 66% and 49%, respectively, and availability was 24% and 11%, respectively. Overall, 15% and 11% of households had ever consumed biofortified beans and OFSP, respectively, and 10% and 2% of households were currently consuming them, respectively. The major bottlenecks to coverage were awareness and availability of the biofortified foods. Conclusions The proposed methods and indicators fill a gap in the availability of tools to assess biofortification program coverage and the results of the survey highlight their utility for assessing program performance and identifying bottlenecks. Further testing is warranted to confirm the generalizability of the coverage indicators and inform their operationalization when deployed in different contexts. Funding Sources Bill & Melinda Gates Foundation.

Download Full-text

Quadruple Fortification of Salt with Iodine, Iron, Vitamins B9 and B12 to Reduce Maternal and Neonatal Mortality by Reducing Anemia and Nutritional Deficiency Prevalence (P24-041-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz044.p24-041-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Venkatesh Mannar ◽

Levente Diosady

Keyword(s):

Folic Acid ◽

Vitamin B12 ◽

Pilot Scale ◽

Iron Core ◽

Ferrous Fumarate ◽

Funding Sources ◽

Spray Solution ◽

Solid Iron ◽

Gates Foundation ◽

Average Size

Abstract Objectives To develop a quadruple fortified salt(QFS) formulation that provides100 + % of RDA for iodine and vitamin B12 and 30–50% of RDA for iron and folic acid in forms that are organoleptically stable, bioavailable and acceptable to consumers Methods Iodine was sprayed onto salt as an aqueous solution of potassium iodate. Iron was admixed as a solid premix, which was colour masked with TiO2 and encapsulated in soy stearine to provide a water-impervious coating. The iron core was made of ferrous fumarate, which was agglomerated to an average size matching salt grain, i.e., 300–500 µm. Folic acid and vitamin B12 were added either in the iodate spray solution or in the solid iron premix. The premixes and salt were stored at 25, 35 and 45°C at 65% RH for up to a year. The loss of iodine, folic acid and vitamin B12 were monitored. An optimized formulation was tested on the pilot scale at JVS Foods Pvt, Jaipur, India. Results Folic acid can be stabilized in the iodine spray solution, and triple fortified salt containing iodine, folic acid and encapsulated ferrous fumarate retained >90% of both the added iodine and folic acid for 6 months. Stable QFS was made by incorporating vitamin B12 in the solid iron premix at a 1:200 ratio. The process was scaled up to produce some 25 kg of iron and B12premix, sufficient for 5 tons of salt, or 500,000 daily doses of salt. Organoleptic testing of Indian meals produced with quadruple fortified salt were found to be acceptable by a consumer panel at the University of Delhi. Conclusions Stable quadruple fortified salt that can provide up to 50% of RDA of folic acid and iron and 100 + % of RDA of vitamin B12 and iodine has been developed. The product was pilot tested and had high consumer acceptability. The formulation could reduce the incidence of maternal and infant mortality at a cost of less than 20¢/annum. Funding Sources This research was funded by Grand Challenges Canada through the Saving Lives at Birth program, and by the Bill and Melinda Gates Foundation.

Download Full-text

Bovine mRNAs in Cow's Milk Exosomes Are Bioavailable and Translated into Peptides in Non-bovine Systems (P06-030-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz031.p06-030-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Di Wu ◽

Jiang Shu ◽

Camila Braga Pereira ◽

Juan Cui ◽

Jiri Adamec ◽

...

Keyword(s):

Bovine Milk ◽

Cell Communication ◽

Mrna Translation ◽

Amino Acid Sequences ◽

Food Allergies ◽

Two Dimensional ◽

Two Dimensional Gel Electrophoresis ◽

Funding Sources ◽

Rabbit Reticulocyte Lysate System ◽

Gates Foundation

Abstract Objectives Exosomes are natural nanoparticles that participate in cell-to-cell communication by transferring regulatory molecules such as microRNAs from donor cells to recipient cells. Previously, we have demonstrated that exosomes and microRNAs are not exclusively obtained from endogenous synthesis but may also be absorbed from milk. We assessed whether 1) exosomes contain mRNAs (i.e., RNAs other than microRNAs), 2) mRNAs are bioavailable in mice, and 3) bovine mRNAs are translated into peptides. Methods For mRNA analysis, exosomes were isolated from bovine milk using differential ultracentrifugation, and RNA cargos were analyzed by RNA-sequencing. For bioavailability analysis, a synthetic fragment of fluorophore (IRDye)-labeled bovine CSN3 mRNA was transfected into bovine milk exosomes, which were administered to Balb/c mice by oral gavage. Tissues distribution of CSN3 mRNA was assessed 24 h after gavage by using a LiCor Odyssey CLx imager. For analysis of mRNA translation, mRNA from bovine milk exosomes were translated using the rabbit reticulocyte lysate system and BODIPY-labeled lysine. Peptides were separated by two-dimensional gel electrophoresis and fluorescence was visualized using a Typhoon FLA 7000 scanner. Statistical analysis, NA. Results We detected > 3600 bovine mRNAs in exosomes. Most mRNAs were truncated; 107 mRNAs contained their natural ATG start codons. Thirteen of these mRNAs, including CSN3, encoded bovine proteins and peptides with amino acid sequences distinct from those in human and murine orthologs (Table 1). Mice absorbed CSN3 mRNA encapsulated in milk exosomes, which accumulated primarily in the liver (Fig. 1). Nine bovine peptide spots were detected by two-dimensional electrophoresis (Fig. 2). Conclusions Bovine milk exosomes contain mRNAs which are bioavailable and translated into peptides in non-bovine systems. We speculate that food mRNAs might play a role in food allergies and immune tolerance. Future studies: Identification of peptides by LC/MS-MS is in progress. We will assess the relevance of mRNA translation for allergies and tolerance in animal models. Funding Sources NIFA, NIH, Gates Foundation, PureTech, Inc. and USDA Hatch and Multistate. J.Z. is a consultant for PureTech. Supporting Tables, Images and/or Graphs

Download Full-text

Maternal Characteristics Affect Fetal Growth Response to Maternal Supplements in the Women First Preconception Trial (WF) (P10-017-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-017-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Michael Hambidge ◽

Carla Bann ◽

Elizabeth McClure ◽

Jamie Westcott ◽

Ana Garces ◽

...

Keyword(s):

Fetal Growth ◽

Maternal Nutrition ◽

Secondary Analysis ◽

Effect Modifier ◽

Mixed Effect ◽

Maternal Characteristics ◽

Funding Sources ◽

Effect Regression ◽

Female Effect ◽

Gates Foundation

Abstract Objectives Determine if maternal characteristics modified newborn anthropometric outcomes in the WF trial (ClinicalTrials.gov NCT01883193). Methods Secondary analysis included combined data for all 1465 maternal infant dyads in WF sites in Guatemala, India, and Pakistan who had 1st trimester ultrasounds and newborn anthropometry with the three WF arms maintained: Arm 1 commenced a comprehensive nutrition supplement ≥3 months prior to conception; Arm 2 commenced the same supplement in the 1st trimester, and Arm 3 received no trial supplements. Maternal characteristics included were: baseline, BMI, hemoglobin, age, education, SES, and parity plus newborn sex. Newborn outcomes were Z-scores for length (LAZ), weight (WAZ), and weight-to-length ratio (WLRZ). Mixed effect regression models were fit for each outcome, including treatment arm, effect modifier, and treatment arm x effect modifier interaction as predictors and controlling for study site, maternal characteristics, and newborn sex. Results Parity, anemia and newborn sex were significant effect modifiers favoring para 0 vs para ≥1, anemia vs non anemia, and newborn male vs female. Effect of Arm 1 vs 3 was significantly larger for para 0 vs ≥1 women on length and weight (Table). Arm 2 vs 3 was not associated with improvements for para 0 in weight (P = 0.273) or WLRZ (P = 0.710). Arms 1 and 2 (vs 3) were associated with significantly higher length, weight, and WLRZ for anemic women. For parity and anemia, effect sizes for Arm 1 were greater than for Arm 2 for WAZ and WLZ (P < 0.05), but not LAZ. Arm 1 and 2 were associated with significantly higher weight and WLRZ for male vs female newborn. Conclusions In diverse low resource populations, impaired fetal growth (weight and length) is substantially improved in nulliparous and in anemic women but minimally or not at all in parous and in non-anemic women. Correction of weight decrements is most pronounced with improvement in maternal nutrition commencing prior to conception. Funding Sources Bill & Melinda Gates Foundation; NIH, NICHD and ODS. Supporting Tables, Images and/or Graphs

Download Full-text

Differences in the Fecal Metabolome and Microbiome Between Exclusive and Partial Breastfed Infants are More Pronounced at 2 Months Compared to 5 Months

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_169 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1097-1097 ◽

Cited By ~ 1

Author(s):

Aidong Wang ◽

Aly Diana ◽

Sofa Rahmannia ◽

Rosalind Gibson ◽

Lisa Houghton ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Feeding Practices ◽

Illumina Miseq ◽

Short Chain Fatty Acids ◽

P Value ◽

Fecal Samples ◽

Breastfed Infants ◽

Funding Sources ◽

Gates Foundation ◽

The Impact

Abstract Objectives This study aimed to characterize the impact of feeding practices on the infant fecal metabolome and microbiome at 2 months and 5 months of age in exclusive breastfeeding (EBF) and partial breastfeeding (PBF) infants. Methods Fecal samples were collected from infants at 2 months and 5 months of age from Bandung, Indonesia. Exclusive breastfeeding was determined using the stable isotope deuterium dose-to-mother (DTM) technique. Fecal metabolites were extracted using Dulbecco's phosphate-buffered saline, and analyzed using NMR spectroscopy. Fecal microbial DNA was extracted at the same time using the MoBio PowerLyzer PowerSoil DNA isolation kit (MoBio, Carlsbad, CA). The V4 region of 16SrRNA was targeted. The DNA library sample was analyzed via 300-bp paired-end sequencing on the Illumina MiSeq platform. Results Fecal samples from EBF infants at 2 months of age revealed significantly higher human milk oligosaccharides (HMOs), short-chain fatty acids and related metabolites compared to PBF infants. However, fecal samples from infants at 5 months of age revealed no differences in metabolome between EBF and PBF after p-value adjustment for multiple comparisons. Gut microbes, especially Bifidobacterium were higher in EBF infants at age 2 months even though not statistically significant. However, this difference was eliminated at age 5 months. Conclusions In the present study, infant feeding practices had a stronger influence on the infant fecal metabolome and microbiome at the age of 2 months as compared to 5 months. Funding Sources 2014 Bill & Melinda Gates Foundation. CS would also like to acknowledge funding from the Kinsella endowed chair in Food, Nutrition, and health as well as USDA-NIFA Hatch project 1,021,411.

Download Full-text

Association Between Prelacteal Feeding and Infant Growth

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_122 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 917-917

Author(s):

Hanzhi Tong ◽

Andrew Thorne-Lyman ◽

Amanda Palmer ◽

Saijuddin Shaikh ◽

Hasmot Ali ◽

...

Keyword(s):

Maternal Education ◽

Low Birthweight ◽

Post Partum ◽

Potential Effect ◽

Infant Growth ◽

Prelacteal Feeding ◽

Project Staff ◽

Adjusted Risk ◽

Funding Sources ◽

Gates Foundation

Abstract Objectives To assess the association between exposure to prelacteal feeding and infant growth from birth to 3 months of age. Methods We analyzed data from a cohort of mothers and infants (n = 2569) identified as part of ongoing pregnancy and birth surveillance in rural Gaibandha, Bangladesh. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within three days post-partum, at one-week, and at three months. At each visit, interviewers collected detailed data on breastfeeding, any foods provided to the infant other than breast milk, and morbidity. Infant weight, length, and mid-upper arm circumference were measured according to standardized protocols at birth and three months of age. For analysis, we defined exposure to prelacteal feeding (PLF) as giving infants any food or liquid other than breastmilk within first 3 days of life. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. Stunting, wasting, and underweight were defined as a LAZ, WLZ, or WAZ < −2, respectively. We used multiple linear regression and multiple logistic regression to assess the association between anthropometric indices and PLF practices, controlling for low birthweight, infant sex, infant age, maternal education, maternal age, and wealth. Results The prevalence of PLF was 25.2%. The prevalence of stunting, wasting and underweight was 29.0%, 3.8% and 22.3%, respectively. For stunting (adjusted risk ratio (ARR) = 1.02 [95% CI: 0.89–1.16]) and wasting (ARR = 0.97 [95% CI: 0.63–1.50]), there were no differences between infants who received PLF and infants who did not receive any PLF. Infants who received PLF tended to have higher risk of underweight (ARR = 1.10 [95% CI: 0.95–1.28]). For LAZ, WAZ, and WLZ score, no differences were observed in the adjusted analysis between infants who received PLF and those who did not receive any PLF. Conclusions There was no association between exposure to PLF and infant growth from birth to 3 months of age. More research is needed to explore the potential effect of PLF on other outcomes. Funding Sources Bill & Melinda Gates Foundation; Johnson & Johnson; UBS Optimus Foundation.

Download Full-text

Development of a Screening Tool to Estimate Vitamin A Intake and Comparison with Detailed Dietary Assessment Methods

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_033 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 182-182

Author(s):

Reina Engle-Stone ◽

Jody Miller ◽

Ame Stormer ◽

Dolly Reario ◽

Mario Capanzana ◽

...

Keyword(s):

Vitamin A ◽

Screening Tool ◽

Dietary Assessment ◽

Food Composition ◽

Funding Sources ◽

Dietary Assessment Methods ◽

Usual Intake ◽

Filipino Children ◽

Gates Foundation ◽

Weighed Record

Abstract Objectives We aimed to develop and validate a tool to estimate vitamin A (VA) intake and identify children at risk of intake above the tolerable upper intake level (UL). Methods We developed, pilot-tested, and refined a screening tool to estimate VA intake among Filipino children 12–18 mo of age. Data were entered into tablets with pre-loaded food composition data to calculate VA intake immediately. The screening tool was used to identify children likely to have “adequate” (one group: 200–500 µg retinol activity equivalents, RAE/d) or “high” (two groups: >600 µg retinol/d) intake. Interviewers administered four 24-h recalls, one 12-h observed weighed record with 12-h recall, and a 30-d supplement questionnaire. Breastmilk intake and VA concentration were measured among breastfeeding children. We compared the screening tool and detailed dietary assessment (DDA) results for primary VA sources, group mean usual intake, and prevalence of intakes above the UL. Results Major VA sources were similar between methods: fortified milk powders, multivitamin supplements, and breastmilk; contributions from intervention programs (e.g., micronutrient powders, fortified staple foods) were low. Mean usual retinol intakes for the high groups (n = 47 and 39, respectively) were 1218 and 1313 µg/d by screening tool vs. 1096 and 931 by DDA; 70 and 77% had usual intake above 600 µg/d. In the adequate group (n = 37), mean total VA intake was 375 and 559 µg RAE/d by screening and DDA, respectively. Conclusions This screening tool provides a reasonably good rapid estimate of VA intake among Filipino children and can be useful for identifying groups with adequate to excessive intakes. Funding Sources Bill & Melinda Gates Foundation.

Download Full-text

Maternal Functional Health Literacy Does Not Predict Child Growth, Development, or Illness from 6 to 18 Mo of Age in Malawi (P11-004-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-004-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Katherine Cox ◽

Ulla Ashorn ◽

John Phuka ◽

Kenneth Maleta ◽

John Sadalaki ◽

...

Keyword(s):

Health Literacy ◽

Child Growth ◽

Functional Health ◽

Growth Charts ◽

Functional Health Literacy ◽

Funding Sources ◽

Nutrient Supplements ◽

Z Scores ◽

Growth Development ◽

Gates Foundation

Abstract Objectives To examine the association of maternal functional health literacy (FHL), a mother's ability to understand health information written in words and pictures, with child health, growth, and development in rural Malawi. Methods Maternal FHL was measured at six months postpartum among 671 participants in the International Lipid-Based Nutrient Supplements (iLiNS) DYAD-M trial in Malawi. Field staff asked comprehension questions about written health materials that were common in Malawi, such as medication instructions, breastfeeding information, and growth charts. Outcomes were child length-for-age (LAZ) and weight-for-length (WLZ) z scores at age 6 and 18 mo, change in LAZ and WLZ from 6 to 18 mo, motor and language development at 18 mo, and illness monitored weekly from birth to 18 mo (highest quartile prevalence of diarrhea, highest quartile prevalence of malaria or undefined fever, and incidence of acute respiratory infection). In Model 1, we examined the unadjusted association between maternal FHL and each outcome. In Model 2, we adjusted for household and parental background characteristics collected at baseline, child age and sex, and trial group. In Model 3, we added maternal cognition, depression, and caregiving characteristics collected after baseline. Results Over 90% of participants understood the growth charts, immunization record, and breastfeeding information in the health passport. Understanding of medication instructions was lower, with 72% understanding malaria, 81% Panadol, and 63% erythromycin instructions (Figure 1). Maternal FHL z score significantly predicted motor (β ± SE = 0.087 ± 0.040, P = 0.029) and language z scores (β ± SE = 0.093 ± 0.040, P = 0.020) at 18 mo in unadjusted models. However, after adjusting for covariates, these associations were not significant. Maternal FHL was not significantly associated with any other outcomes. Conclusions Revision of written medication instructions in Malawi may be needed to increase mothers’ understanding of how to deliver medication to their children. However, in this sample, maternal FHL was not associated with indicators of child growth, development, or illness after adjusting for parental, household, and caregiving characteristics. Funding Sources This publication is based on research funded by a grant to the University of California, Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs

Download Full-text