Effect of Consuming Small-Quantity Lipid-based Nutrient Supplements on Breast Milk, Energy and Nutrient Intake and the Association Between Amount of Breast Milk Intake and Growth and Development of Malawian Rural Children

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Arvo building, auditorium F114, address: Lääkärinkatu 1.

Doctoral defence of MSc Chiza Kumwenda

Effect of Consuming Small-Quantity  Lipid-based Nutrient Supplements  on Breast Milk, Energy and  Nutrient Intake and the Association  Between Amount of Breast Milk  Intake and Growth and Development  of Malawian Rural Children

The field of science of the dissertation is International health.

The opponent is Professor Harri Niinikoski (University of Turku). Professor Per Ashorn acts as the custos.

The language of the dissertation defence is English.

Effect of Consuming Small-Quantity Lipid-based Nutrient Supplements on Breast Milk, Energy and Nutrient Intake and the Association Between Amount of Breast Milk Intake and Growth and Development of Children

Stunting remains a big public health problem in Malawi. Thirty-seven percent of under-five children are stunted in Malawi. While at global level there has been a significant reduction in stunting levels, currently at 27%, Malawi has failed to register significant progress towards reducing stunting. One of the major factors contributing to high levels of stunting in Malawi is suboptimal infant and young child feeding practices, including poor breastfeeding and dietary practices. So far evidence is lacking on the contribution of the amount of breast milk on infant and child growth and development after 6 months of exclusive breastfeeding.

The present study had four aims; to assess the effect of small quantity lipid-based nutrient supplement (SQ-LNS) on breast milk intake, to assess energy and nutrient intake among infants whose complementary foods were supplemented with SQ-LNS and those in the control group, to assess determinants of breast milk intake and finally to assess the relationship between amount of breast milk and growth and development among infants and young children age 9–18 months in Malawi. To measure the amount of breast milk intake, the dose-to-mother deuterium dilution technique was used, the method is currently considered the gold standard in assessment of breast milk intake in community settings. Energy and nutrient intakes were assessed using the interactive-24 hour dietary recall method. Motor and language development among infants at 18 months of age were assessed using the Kilifi Developmental Inventory (KDI) and adapted version of the MacArthur-Bates Communicative Development Inventory respectively. Regression analysis was used to determine predictors of breast milk intake and to assess the association between amount of breast milk and growth and development. The present study was conducted in Mangochi district, south of Malawi, Southern Africa.

Intake of breast milk among 9–10 months old infants (n=359) was not significantly different between those supplemented with SQ-LNS at a dose ranging from 10 to 40g/d and infants in the control group who did not receive SQ-LNS.

The overall mean (SD) and the mean (SD) daily breast milk intake of infants in the control arm was 752.0 (244) and 730.6 (226) g respectively. The differences (95% CIs) in mean intake of infants provided with 10, 20, or 40 g SQ-LNS/d, compared with controls, were +62 (-218, +143), +30 (-240, +99), and +2 (-268, +72) g/d, respectively. Children in the SQ-LNS intervention groups had significantly higher dietary energy, protein and fat intakes than those in the control group. However, no significant differences were observed in median intakes of energy from non-SQLNS complementary foods implying that SQ-LNSs increased intakes of energy and macronutrients without displacing locally available complementary foods.

To study the predictors of breast milk intake, path analysis was performed prior to conducting regression analysis, in order to establish potential causal relationships between variables. The regression analysis demonstrated that infant breast milk intake was significantly predicted by infant weight, and the following maternal factors, height, age and education.

An increase in body weight of an infant by 1kg was associated with an increase in breast milk intake of 68g per day. On the other hand, an additional year spent in school by the mother was associated with a reduction in breast milk intake by about 11g per day. An increase in maternal age by a year was associated with a reduction in amount of breast milk intake by 6.5 grams, while an additional centimetre of maternal height was associated with an increase in breast milk intake by almost 7 grams.

The association between breast milk amount and growth and development was assessed using both univariate and multiple regression analyses. In multiple regression, breast milk intake (g/d) at 9–10 months was not associated with either growth between 12 and 18 months or development at 18 months, but was positively associated with attained length for age-z score at 12 months.

In conclusion supplementation of complementary foods with SQ-LNS did not result in reduction in breast milk intake at 9–10 months of age and displacement of complementary foods among rural Malawian infants. Amount of breast milk intake during later infancy was not associated with growth and development in early childhood. Infant weight, maternal height, age and education were the main predictors of breast milk intake among Malawian infants. Therefore, promotion, support and protection of optimal breastfeeding practices should continue to be part of the public health nutrition messages, while improvement of complementary foods with products like SQ-LNS should also be advocated for.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2246, Tampere University Press, Tampere 2017. ISBN  978-952-03-0313-6, ISSN 1455-1616. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1746, Tampere University Press 2017. ISBN 978-952-03-0314-3, ISSN 1456-954X.

Additional information

Chiza Kumwenda, ckumwenda@bunda.luanar.mw