The Mazira Project: An Evaluation of Eggs During Complementary Feeding in Rural Malawi
Condition: Infant Malnutrition
MeSH terms: Malnutrition; Infant Nutrition Disorders
Study type: Interventional

Summary: 
      The Mazira Project is a study of the effect of egg consumption on growth, development and gut
      health of infants in Malawi. The study randomly assigns infants to receive one egg per day
      over six months or to receive an equivalent value of food at the end of six months. Growth,
      achievement of developmental milestones, gut microbiome composition and other measures of
      nutritional status are compared between the two groups to determine whether regular egg
      consumption benefits Malawian infants.
    

Detailed description: 
      The aim of the Mazira Project is to determine whether daily consumption of an egg improves
      the growth and development of infants in rural Malawi. In Malawi, 37% of children under five
      years old are stunted, or shorter than expected for their age (1). Most stunting occurs when
      children are less than 2 years old. Stunting is a sign of long-term undernutrition and is
      associated with delayed cognitive development. Eggs provide protein, fatty acids, vitamin
      B12, choline and other nutrients that may support healthy growth and cognitive development.
      In a previous trial in Ecuador, infants who were provided eggs for daily consumption showed
      improved growth and lower rates of stunting than infants who were not provided eggs (2).

      Investigators are assessing whether children who consume eggs regularly over six months
      starting when they are 6 to 9 months old have higher height-for-age scores and lower rates of
      stunting than children who do not consume eggs regularly. Investigators are also assessing
      whether egg consumption improves Malawian infants' cognitive development. Because gut health
      is important for good nutrition, they are testing whether eggs have positive effects on
      measures of gut health and the gut microbiome. Finally, they are exploring the various
      metabolic pathways by which the nutrients available in eggs may influence infant growth and
      development.

      Participants are individually, randomly assigned to the egg intervention group or the control
      group. The mothers of infants who are randomly assigned to the egg intervention group receive
      14 eggs each week and are asked to feed the infant one egg each day. Extra eggs are provided
      because sharing of food is common in Malawian households. The mothers of infants who are
      randomly assigned to the control group receive a package of foods at the end of the study
      that is equal in value to the eggs. Each mother/infant pair participates in the study for six
      months.

      When infants are enrolled, a baseline assessment is completed. This assessment includes a
      blood draw plus testing for anemia and malaria, anthropometric measurements, developmental
      assessments, 24-hour dietary recall interview, infant health history questionnaire. Mothers'
      heights and weights are also measured, and each mother is asked about socio-economic and
      demographic indicators and food security in her household. The anthropometric, dietary and
      development assessments are repeated after 3 months. At the end of the six month study
      period, anthropometric, dietary and development assessments are repeated, along with another
      blood draw.

      Additional data collected during the course of the study include: repeat 24-hour dietary
      recalls and monthly stool sample collection among a subsample of 200 children; twice-weekly
      observations of the index infant's egg consumption in the egg group or short questionnaire
      about the index infant's most recent meal in the control group; weekly morbidity history and
      animal source food consumption questionnaire among all infants; and focus groups and key
      informant interviews about production, availability and consumption of eggs among communities
      in the study area.
    

Intervention name(s): Eggs; Visits
Intervention type(s): Other; Behavioral
Intervention description(s): Eggs provided as complementary food for the infant; Twice weekly household visits by study staff
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: complementary feeding; eggs; infant growth; stunting; cognitive development; choline; vitamin B12; microbiome