COMPLEMENTARY FOOD FOR AFRICA

NEW PRODUCTS AND APPROACHES FOR IMPROVED CHILDHOOD NUTRITION

Early Childhood Nutrition Study

Early Childhood Nutrition Study

• Study the acceptability and feasibility of a soy-blend weaning food made with orange-fleshed sweet potato (aka ComFA)

• Enrolled 176 mother-infant pairs in northern Ghana

• Surveyed three ComFA formulations against Weanimix

ECN STUDY: Treatments and key nutrients

Ingredient ComFA +Anchovies +Moringa WeaniMixOFSP 70% 70% 70% -Soy meal 30% 20% 25% 15%Anchovies - 10% - -Moringa - - 5% -Maize - - - 75%Groundnuts - - - 10%

Energy kcal/100 g db 395 378 374 395

Protein g/100 g db 15.7 17.4 15.3 14.7

Iron mg/100 g db 6.6 5.6 7.2 4.8

Vit A ug RAE/100 g db 2521.8 2547.9 2522.25 0.9

Webinar Schedule• 9:00am: Introduction: Soybean Innovation Lab Introduction & What is ComFA?

• 9:10am: Why was ComFA developed? The nutritional content and advantages of ComFA(Dr. Francis Amagloh)

• 9:15am: Experiences from the field: methods and challenges implementing the study (Mawuli Asigbee and Philip Atiim from CRS)

• 9:20am: Video footage from the study

• 9:30am: Relevance of acceptability and feasibility trials & ECN Study Results (Dr. Juan Andrade)

• 9:40am: Institutional Partnerships: How development agencies and research institutes can partner with SIL to improve early childhood nutrition in Africa

• 9:45am: Q&A

SIL Human Nutrition ObjectivesExpand the use of soybeans among diverse populations in low-income settings

• Increase soy integration into household diets• by adapting diverse forms of soy to local cuisines and flavors• through NGO-capacity trainings on food processing, food safety, and nutrition education

• Introduce soy to institutional feeding programs • through food processing instruction, soy food supplier networking, and policy lobbying• School Lunch Programs

• Support soy food enterprises • through training on equipment use, food safety and packaging, marketing, FDA certification, and

business development• Increase production capacity of medium and large-scale soy processing plants to increase market

availability of soy foods • Increase the availability of soy foods on local markets

COMFA:OFSP-SOY BASED INFANT FOOD FOR

AFRICAFrancis Kweku Amagloh, PhD

Department of Food Science and Technology

University for Development Studies

Background• Most common complementary foods (CFs) given to infants in

Ghana are cereal-based

• Maize (white predominately), millet or sorghum

• To improve the energy and protein amount and quality, cereals are blended with legumes (soyabean, cowpea, and groundnut/peanut)

• Cereal and legumes are high in phytate

• Limits micronutrient bioavailability

• Maize and groundnut have greater risk of aflatoxin contamination

• Associated with micronutrient deficiencies and undernutrition (stunting and underweight)

• White maize and legumes are low in provitamin A

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What is ComFA?

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FormulationProportion on “as-is” basis per 1 kg. Values in grammes except for water

OFSP Soy Anchovies Moringa Maize Groundnut Sugar Veggie OilWater used (kg)

ComFA 700 300 11

1.9ComFA + Anchovies

700 200 100 11

ComFA + 5% Moringa

700 250 50 11

Weanimix 150 750 100 267 5.6Preparation Peeling

and dicing

Roasting, dehulling &

milling

Breaking heads off &

milling

Shade drying & milling

Roasting and Milling

Roasting, dehulling and

milling

Add to pot Add to pot

Compounds Weanimix ComFA

Simple sugar (g/100 g) 2.55 21.60Maltose (g/100 g) 10.31 20.38Starch (g/100 g) 30.93 13.19Vit A (µg RAE/100 g) 2.83 1112.75Ascorbic acid (g/100 g) ND 0.03Phytate (g/100 g) 0.44 0.23Total polyphenols (g GAE/100 g) 213.45 466.27

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Amagloh, F. K., & Coad, J. (2014). Orange-fleshed sweet potato-based infant food is a better source of dietary vitamin A than a maize-legume blend as complementary food. Food and Nutrition Bulletin, 35(1), 51-59.

Compositions of Weanimix Vs. ComFA, prepared at the household-level

ECN STUDY: % ingredient contribution to energy and key nutrients

Acceptability test scores of Weanimix & ComFA formulations

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Fig. 1.: Median scores for overall degree of liking by mothers of Weanimix and ComFA formulations in two communities in Northern Ghana.

Mothers accepted all ComFA formulations in the same degree as they accepted Weanimix.

Overall Liking

ComFA

ComFA+Anchovies

ComFA+5% Moringa

WeanMix

Like

rt sc

ale

(1-3

)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Acceptability test scores of Weanimix & ComFA formulations

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According to the mothers, ComFA with Anchovies and Moringa were perceived as less liked by children (p<0.01)

Perception of Mother on Child liking the product

ComFA

ComFA+Anchovies

ComFA+5% Moringa

WeanMix

Like

rt sc

ale

(1-3

)

0

1

2

3

4

Fig. 2.: Median scores for overall degree of liking by child’s as reported by their mothers of Weanimix and ComFA formulations in two communities in Northern Ghana.

Conclusions about ComFA• ComFA is a nutritious and safe alternative CF for children in rural Ghana

• ComFA provides energy and a significant quota of vitamin A and quality protein

• ComFA is naturally sweet, reducing the need to add sugar

• ComFA is less susceptible to aflatoxin contamination, limiting its risk

• During preparation, ComFA requires less fuel and water, which could result in household savings. More research needs to be done at this point to evaluate how ComFA’s essential nutrition can also be more cost effective.

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Thank you

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Healthy, Happy

Ghanaian kid

ECN SURVEY METHODOLOGY AND CHALLENGES

Mawuli AsigbeeAgriculture Program Manager

Philip AtiimAgriculture Senior Program Officer

Sites selection (Geographical)• Two (2) sites /district were selected across 2 regions.

The choices were made based on factors that included the following:• Districts are covered by CRS activities• Districts have had nutrition related activity

implemented for the purpose of continuity & building on successes.

• District have a health post/clinic to facilitate easy access to lactating mothers and support from health workers.

• Working in two (2) regions allowed for behavior evaluation between 2 ethnic groups

• GHS approval for the survey process facilitated by Dr. Amagloh.

Region District Community

Northern Tolon Yipeligu

Upper East Talensi Awaradone

Enumerator Selection and Training1. Eight (2m/6f) enumerators with CITI certification

were selected. Four for each site.

2. Training for enumerators was conducted by Dr. Francis Amagloh in Tamale.

3. Enumerators had full understanding of concept and methodology.

4. District and community stakeholders were informed.

5. ECN survey posters (in English and local languages) produced and posted at health centers and community market squares to help recruit mothers

Participant Selection• The mother infant-pairs were recruited from GHS Child

Welfare Clinics (CWCs) in the 2 communities.

• For each district, 60 mother-infant pairs were purposively sampled and randomly grouped into four for the acceptability test while 40 mothers took part in a 2 week feasibility evaluation.

• The feasibility group prepared and fed their kids on all the 4 recipes while the acceptability group were given ration to take home for testing.

• Names of participants were written and a daily register marked to ensure that all mothers attended.

• Both categories were coached jointly on the survey purpose and process and their roles in the survey. This was after they had signed consent forms to participate at will.

Survey sessions1. Community entry and sensitization with chiefs, elders, and

members of the 2 communities preceded the survey.

2. Survey grounds selected with guidance by community elders.

3. Survey set up: grouping of enumerators, allocation of cooking utensils, plates and spoons, scales and ingredients were allocated to each of the groups.

4. Nursing mothers were divided into two categories for acceptability and feasibility evaluation.

5. Four groups of 20-30 nursing mothers set up with 2 enumerators to prepare each of 4 recipes in rotation.

6. Focus group discussions were employed and resourced with interviewers and voice recorders to elicit, and document data and information.

Data collection• The different formulations of ComFA and the

control Weanimix were weighed, served out to mothers to feed the children. • Data collected:

• feeding time• quantity consumed by children • remaining food

• Both feasibility and acceptability data was captured digitally on iForms builder software using iPads.

• This allowed all team members to have access to the daily data as they were inputted and uploaded.

Presentation of Hampers• Brief community forums were held in each community to

close the surveys.

• Community leaders and stakeholders (GHS Nutrition staff) were duly acknowledged for their support.

• Mothers were presented with hampers (rice, oil, mackerels, tomatoes) for their time and participation.

Challenges with Implementing the Study

• Difficulty in coordinating purchasing of logistics and ingredients by different partners

• Difficulty in understanding the quality and units in which some ingredients had to be procured and level of processing required (including specifications for materials, gadgets and utensils).

• Initial complains and lack of cooperation from some mothers due to length of time spent at each session. Future sessions may start in the afternoon when mothers would have finished fetching water and other household chores.

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THANK YOU

RELEVANCE OF ACCEPTABILITY AND FEASIBILITY TRIALS &

ECN STUDY RESULTS

Juan E. Andrade, Ph.D.Principal Investigator, SIL Human Nutrition Research Area

Department of Food Science and Human Nutrition

University of Illinois-Urbana-Champaign

Ener

gy In

take

(K

cal/d

ay)

Complementary Foods (semi-fluid)

Family Foods (fluid, semi-solid,

and solid)

Child AgeModified from WHO/NUT 98.1

Breast Milk (fluid)

Exclusive breastfeeding

Complementary Feeding

Contribution of complementary foods to energy intake

6 months 24 months

Complementary foods: ACTS Key elements

Adequate• Nutrition, consistency, and palatability

Context-specific• Culture, demographics, season

Timely• Time of introduction and frequent

Safe• Physical, chemical and biological

Key Elements in Food Choices

Food Choices

Cost

Taste

Variety

Well-being

Culture and

personal beliefs

Convenience

Kittler PG, Sucher KP. Food and Culture. 4th ed. Belmont, California, Wadsworth/Thompson Learning, 2004

Sensory acceptability and feasibility studies

examine these aspects of a food

Feasibility Study• Women (n = ~20/group), from two

communities Yipelgu and Awaradone

• Women tested the different food products for 2 weeks.• Day one: training• Day two: follow up at home• Day seven: food supply • Day 14: focus groups

• Applied a semi-structured questionnaire, mixed open-ended and closed questions

• Focus groups lasted 1 hour

Feasibility study: women ratings in terms of ease of preparation

Chi-square test of independence (χ2 = 7.06; P=0.07)

Chi-square test of independence (χ2 = 3.377; P=0.33)

Feasibility study: mothers’ perceptions about the ease of consumption of project’s products by their children

Feasibility Study: Women comments from focus groups

90% of participants would recommend new complementary products to their families.

Those who wont recommend (9%), mentioned the strong flavor of moringa or anchovies.

“It is nutritious especially the soya beans added.”-Participant from Awaradone

“I would recommend… because the ingredients are simple and available for easy adoption.”

- Participant from Yipelgu

“I would recommend… because wish all community member to benefit to help alleviate poverty.”

- Participant from Yipelgu

THE WAY FORWARD

SIL Model for Successful Complementary Nutrition

Needs assessment / context

Food and nutrient analysis

Sensory

Feasibility and cost

Knowledge creation/sharing

THANK YOU!Q & A: Send in your questions using the chat box!