Nutrition Capacity Building to Meet National Priorities: Lessons Learned in Developing and Implementing Malawi's First Dietetics Program.

The current nutrition situation in Malawi, characterized by high rates of malnutrition in communities and hospitals and a rapidly increasing burden of overweight/obesity and diet-related noncommunicable diseases, highlights the urgent need for registered dietitians, who have a proven track record in the prevention and management of all forms of malnutrition and improving patient outcomes. However, dietetics practice has been described as underdeveloped and fragmented in many parts of Africa, exacerbated by a severe and chronic shortage of dietetics professionals and a lack of nutrition and dietetic education programs in most African countries.We share early lessons learned in the development and implementation of the first dietetics program in Malawi. Within 6 years, the program produced 10 graduate dietitians who have filled the first clinical dietitian posts in Malawian public hospitals. This early success can be attributed to the model used to develop and implement the program, which included early stakeholder engagement to define the priority skills and competencies of a Malawian dietitian, the use of internationally recognized training standards, and the development of strategic institutional partnerships that brought together complementary skills and expertise. Furthermore, using existing resources and recruiting students with a nutrition and health background accelerated implementation. The current dietetics curriculum responds to the national nutrition and health policy direction and strategic objectives. Early and sustained government engagement was crucial in creating demand and securing career prospects for graduates. Although still in its infancy, dietitians in Malawi are poised to contribute significantly to alleviating the country's complex nutrition challenges.

Sensory and nutritional properties of peanut-based beverages: a promising solution for undernutrition in Malawi and possibly beyond.

BACKGROUND: Undernutrition remains a challenge in countries like Malawi. The search for effective nutrition interventions to address this challenge is ongoing. In this study, the sensory profiles of six peanut-based beverage prototypes were determined. Three of the prototypes had barley malt in their formulations, and the other three had sorghum malt in their formulations. Nutrient profiles were determined using official standard analytical methods, and the results were compared with daily nutrient requirements to estimate their nutritional value. RESULTS: All the six prototypes were acceptable, with mean overall liking scores ranging from 7.0 to 7.6. Prototypes containing sorghum malt were perceived as tasty, creamy, thick, and whitish, whereas those containing barley malt were perceived as sweet, watery, and brown. These terms, except whitish, had a significant impact (P < 0.05) on the overall liking mean score. The formulation incorporating sorghum malt (F-B) had a better nutrient profile than that containing barley malt (F-A) in terms of protein, total dietary fiber, potassium, phosphorus, calcium, magnesium, iron, and zinc. A 237 mL (8 oz.) serving of F-B was an excellent source (% DV ≥20) of high-quality protein, total dietary fiber, phosphorus, calcium, molybdenum, and manganese, and a good source (10 ≤ % DV < 20) of potassium and magnesium. CONCLUSION: Based on consumer acceptability, both formulations can potentially increase peanut consumption in Malawi. Given its nutritional quality, F-B may help in the management of undernutrition. The peanut-based beverage may also be valuable in other countries, besides Malawi, where undernutrition is also a challenge. © 2020 Society of Chemical Industry.

Hydrothermally Treated Soybeans Can Enrich Maize Stiff Porridge (Africa's Main Staple) without Negating Sensory Acceptability.

Maize-based stiff porridge, a starchy protein-deficient staple food, dominates among the populations in sub-Saharan Africa (SSA). Unfortunately, this is often consumed along with leafy vegetables since the majority of the population in this region lack resources for the purchase of high protein animal source foods, a situation that exacerbates protein-energy malnutrition. Considering this, the current study evaluated the effect of enriching maize-based stiff porridge with flour made from hydrothermally treated soybeans on consumer acceptability. A total of nine experimental flours were prepared from maize and maize-soybean mixtures following a 32 factorial design involving two factors, namely maize flour type (whole maize, non-soaked dehulled maize, and soaked dehulled maize) and soybean flour proportion (0%, 20%, and 30%). A total of 125 adult consumers from a rural setting in Malawi evaluated maize-based stiff porridges made thereof using a 7-point hedonic scale. Subsequently, the participants were asked to guess an ingredient that was added to some of the test samples. The 10% and 20% soybean-enriched maize-based stiff porridges scored 5/7 and above, with some being statistically similar to plain maize-based stiff porridges. No participant recognized that soybeans were incorporated into the maize-based stiff porridges. The study has clearly demonstrated the potential of enriching maize-based stiff porridge with hydrothermally treated soybeans without compromising consumer acceptability. This innovation could significantly contribute towards reducing the burden of energy-protein under-nutrition in SSA.

Effect of cowpea flour processing on the chemical properties and acceptability of a novel cowpea blended maize porridge.

Childhood growth stunting is a pervasive problem in Malawi and is in large part due to low quality complementary foods and chronic gut inflammation. Introducing legumes such as cowpea (Vigna unguiculata) into the complementary diet has the potential to improve childhood growth by improving diet quality through improvements in macro- and micronutrients and also by reducing gut inflammation. However, cowpea is relatively underutilized in complementary feeding in Malawi due to its strong taste, long processing time, and high energy requirements for processing. Effective utilization of cowpea in complementary feeding requires processing which may affect chemical composition as well as sensory quality. The present study evaluated the effect of processing on the retention of zinc, crude fibre, and flavonoid in roasted, boiled, and dehulled cowpea flours, and assessed the acceptability of maize porridge (70%) enriched with one of the three cowpea flours (30%). Roasting, dehulling, and boiling did not have any effect on zinc content. Crude fibre content increased after processing by all methods. Processing had no effect on measurable flavonoids. Roasted, boiled, and dehulled cowpea blended maize porridges were acceptable to children with mean quantities of leftover food of less than 3g from the given 100g. Caregivers also rated the blended flours to be highly acceptable to them as well, with maize porridge blended with dehulled cowpea flour the most acceptable to both children and caregivers. These results demonstrate that cowpea flour, processed by any of these three different methods, could serve as a useful addition to maize porridge for complementary feeding of children in sub-Saharan Africa.

Targeting caregivers with context specific behavior change training increased uptake of recommended hygiene practices during food preparation and complementary feeding in Dedza district of Central Malawi.

The effect of a targeted training intervention on uptake of recommended hygiene practices by caregivers of children 6-23 months was assessed. A sub-sample of 40 mothers from 303 households was used for a detailed study of hygiene practices during preparation of complementary foods after training. Mothers and caregivers were observed for 6 months and evaluated using a questionnaire. Data were analyzed using SPSS and Chi-square test was used to determine the differences in proportions of mothers and caregivers who adopted recommended practices. Results showed significant increase in the proportions of mothers and caregivers who followed recommended hygiene practices after training. There was significant decrease in prevalence of diarrhea among the children (45% to 8.6%). It can be concluded that targeted training on practical hands-on activities such as hand washing, cleaning of cooking and serving utensils, covering of food and water increase adoption of recommended hygiene and sanitation practices.

How immediate and significant is the outcome of training on diversified diets, hygiene and food safety? An effort to mitigate child undernutrition in rural Malawi.

OBJECTIVE: The present study examined the impacts of training on nutrition, hygiene and food safety designed by the Nutrition Working Group, Child Survival Collaborations and Resources Group (CORE). DESIGN: Adapted from the 21d Positive Deviance/Hearth model, mothers were trained on the subjects of appropriate complementary feeding, water, sanitation and hygiene (WASH) practices, and aflatoxin contamination in food. To assess the impacts on child undernutrition, a randomised controlled trial was implemented on a sample of 179 mothers and their children (<2 years old) in two districts of Malawi, namely Mzimba and Balaka. Settings A 21d intensive learning-by-doing process using the positive deviance approach. SUBJECTS: Malawian children and mothers. RESULTS: Difference-in-difference panel regression analysis revealed that the impacts of the comprehensive training were positive and statistically significant on the Z-scores for wasting and underweight, where the effects increased constantly over time within the 21d time frame. As for stunting, the coefficients were not statistically significant during the 21d programme, although the level of significance started increasing in 2 weeks, indicating that stunting should also be alleviated in a slightly longer time horizon. CONCLUSIONS: The study clearly suggests that comprehensive training immediately guides mothers into improved dietary and hygiene practices, and that improved practices take immediate and progressive effects in ameliorating children's undernutrition.

Glycemic responses to maize flour stiff porridges prepared using local recipes in Malawi.

Glycemic index is defined as the incremental area under the blood glucose response curve of a 50 g carbohydrate portion of a test food expressed as a percent of the response to the same amount of carbohydrate from a standard food taken by the same subject. This study investigated glycemic index of maize stiff porridges consumed as staple food in Malawi and a large majority of other countries in sub-Saharan Africa to identify areas for improvement in consumer diets. Stiff porridges were prepared using flour from whole maize, maize grits, and fermented maize grits. The porridges were served to 11 healthy volunteers for 3 weeks, with two serving sessions a week. Glucose was served as a reference food during weekly serving sessions. Results from descriptive analysis revealed that glycemic responses varied across subjects and porridge types. Porridge prepared from fermented maize grits had moderate glycemic index of 65.49 and was comparable in nutrient composition and sensory characteristics with the other test porridges. Glycemic indices of the porridges prepared from whole maize flour and grits were high at 94.06 and 109.64, respectively, attributed to the effect of traditional maize flour processing, preparation, and cooking methods used. The study also calculated glyaemic load of the porridges and drew recommendations to inform diet planning and modifications for healthy and diabetic individuals.

Metabolite changes during natural and lactic acid bacteria fermentations in pastes of soybeans and soybean-maize blends.

The effect of natural and lactic acid bacteria (LAB) fermentation processes on metabolite changes in pastes of soybeans and soybean-maize blends was studied. Pastes composed of 100% soybeans, 90% soybeans and 10% maize, and 75% soybeans and 25% maize were naturally fermented (NFP), and were fermented by lactic acid bacteria (LFP). LAB fermentation processes were facilitated through back-slopping using a traditional fermented gruel, thobwa as an inoculum. Naturally fermented pastes were designated 100S, 90S, and 75S, while LFP were designated 100SBS, 90SBS, and 75SBS. All samples, except 75SBS, showed highest increase in soluble protein content at 48 h and this was highest in 100S (49%) followed by 90SBS (15%), while increases in 100SBS, 90S, and 75S were about 12%. Significant (P < 0.05) increases in total amino acids throughout fermentation were attributed to cysteine in 100S and 90S; and methionine in 100S and 90SBS. A 3.2% increase in sum of total amino acids was observed in 75SBS at 72 h, while decreases up to 7.4% in 100SBS at 48 and 72 h, 6.8% in 100S at 48 h and 4.7% in 75S at 72 h were observed. Increases in free amino acids throughout fermentation were observed in glutamate (NFP and 75SBS), GABA and alanine (LFP). Lactic acid was 2.5- to 3.5-fold higher in LFP than in NFP, and other organic acids detected were acetate and succinate. Maltose levels were the highest among the reducing sugars and were two to four times higher in LFP than in NFP at the beginning of the fermentation, but at 72 h, only fructose levels were significantly (P < 0.05) higher in LFP than in NFP. Enzyme activities were higher in LFP at 0 h, but at 72 h, the enzyme activities were higher in NFP. Both fermentation processes improved nutritional quality through increased protein and amino acid solubility and degradation of phytic acid (85% in NFP and 49% in LFP by 72 h).

Sensory evaluation and consumer acceptance of naturally and lactic acid bacteria-fermented pastes of soybeans and soybean-maize blends.

Fermented pastes of soybeans and soybean-maize blends were evaluated to determine sensory properties driving consumer liking. Pastes composed of 100% soybeans, 90% soybeans and 10% maize, and 75% soybeans and 25% maize were naturally fermented (NFP), and lactic acid bacteria fermented (LFP). Lactic acid bacteria fermentation was achieved through backslopping using a fermented cereal gruel, thobwa. Ten trained panelists evaluated intensities of 34 descriptors, of which 27 were significantly different (P < 0.05). The LFP were strong in brown color, sourness, umami, roasted soybean-and maize-associated aromas, and sogginess while NFP had high intensities of yellow color, pH, raw soybean, and rancid odors, fried egg, and fermented aromas and softness. Although there was consumer (n = 150) heterogeneity in preference, external preference mapping showed that most consumers preferred NFP. Drivers of liking of NFP samples were softness, pH, fermented aroma, sweetness, fried egg aroma, fried egg-like appearance, raw soybean, and rancid odors. Optimization of the desirable properties of the pastes would increase utilization and acceptance of fermented soybeans.