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. 2008 Jan;4(1):65-73.
doi: 10.1111/j.1740-8709.2007.00098.x.

Feeding Patterns of Underweight Children in Rural Malawi Given Supplementary Fortified Spread at Home

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Feeding Patterns of Underweight Children in Rural Malawi Given Supplementary Fortified Spread at Home

Valerie L Flax et al. Matern Child Nutr. .
Free PMC article


Fortified spread (FS), containing dry food particles embedded in edible fat, offers a convenient means for nutrition rehabilitation. To describe how caregivers feed FS to their undernourished children at home, and how FS use affects other feeding patterns, we conducted a longitudinal observational study in rural Malawi. Sixteen 6- to 17-month-old underweight children (weight-for-age z-score < -2.0; -3.0 < weight-for-height z-score < 0) received FS for 12 weeks. Twelve-hour observations were conducted before supplementation and during weeks 1, 4, 8 and 12 of FS use. FS was fed to children about two times per day; each serving was 15-20 g. The spread was first used mainly alone as a between-meal snack, and then became integrated into the typical complementary feeding pattern by being mixed with porridge. Introduction of FS reduced the number of plain porridge meals, but did not decrease the total number of meals or breastfeeds per day and did not change the daily mean time caregivers spent on feeding. Children accepted the FS well, but more FS was wasted when it was offered mixed with porridge than when given alone (23.6% vs. 1.2%, 95% CI for the difference 13.2% to 31.6%). FS supplementation is feasible for community-based nutrition interventions in Malawi because it easily becomes part of the feeding routine, does not replace other foods and does not take extra caregiver time. To limit wastage, caregivers should be advised to serve FS plain or to mix it with only a small quantity of porridge.


Figure 1
Figure 1
Number of food episodes and mean daily feeding time by study week. Figure 1a,b is based on data from feeding logs. In Fig. 1a, the sum of the number of feeding episodes during each study week is presented. In Fig. 1b, the mean daily feeding time for each type of food during each study week was adjusted for within‐subject correlation. During week 0, no FS (fortified spread) was provided to participants. FS was available to participants during weeks 1, 4, 8 and 12. Porridge = maize, rice or maize/soy, approximately 10% dry matter; FS mixed = spread mixed with porridge; FS alone = spread given straight from the jar; nsima = dough made from maize, approximately 28% dry matter, and relish = side dish made of green vegetables, fish or beans; other meals = rice or boiled pumpkin; snacks = small quantities of food eaten between meals (such as banana, bread, roasted maize).

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