MannaPack™ Potato Clinical Trial Wilna Oldewage-Theron PhD RD (SA) & Abdulkadir Egal PhD (PH)‏

OUTLINE OF PRESENTATION Introduction Background Stakeholders Methods Results Limitations Conclusions Recommendations

BACKGROUND: South Africa million (SSA 2009)‏ 40% live in poverty (Cunnan & Maharaj, 2000:669, SA Govt, 2001)‏ 2.5% hungry (1.23 million people household food insecurity) (SSA 2009)‏ 20% of SA children stunted 33.3% iron deficiency anaemia in children and women 45.3% children at risk of zinc deficiency 10% of children overweight (Labadarios et al., 2008) 16.6% HIV and AIDS prevalence (WHO Stats, 2008)‏

INTRODUCTION Diarrhea = one of the top killers of children around the world Solution = medication or oral rehydration fluids

INTRODUCTION FMSC - new product, MannaPack™ Potato (MPP) to provide a “first food” in response to diarrhea  Dehydrated potato granules (resistant starches)‏  Lecithinated soy flour (protein source)‏  Gum arabic (soluble fiber)‏  Vitamins and minerals  Mild sweet potato flavoring Reduce the impact of diarrhea and maintain the gut during diarrhea and recovery.

MannaPack™

MAIN AIM Overall purpose of the project was to document the actual impact and acceptability of MannaPack™ to reduce the impact and support resolution of the symptom of chronic and acute diarrhea.

SPECIFIC OBJECTIVES  Assess the acceptability of MannaPack™ in a setting that provides care and treatment for children with diarrhea.  Assess the impact of MannaPack™ on the quality and quantity of acute and chronic diarrhea in a community setting.

STAKEHOLDERS

PROJECT METHODS 1. Planning Ethics approval (M080365) Strategic participatory planning workshop with all stakeholders in South Africa (SA)‏ Two crèches in the Vaal region identified (control group)‏ SOS village for HIV/AIDS-affected orphans in Qwa-Qwa (experimental group). Consent Training of data enumerators and monitors

PROJECT METHODS 2. Measurements Diarrhea questionnaire - baseline + 6 weekly Sensory questionnaire – baseline and end

PROJECT METHODS 2. Measurements Weight and height, handgrip, skin tenting & nail blanching – baseline + 6 weeks

PROJECT METHODS 3. Intervention

QWA-QWA BACKGROUND 5 people per household (hh)‏ 89.9% of caregivers unemployed 67.4% of partners unemployed 59.1% of hh < R 1000 (US$133) pm 51.0% hh food insecurity

4.9 people per hh 94.1% of caregivers unemployed 80.1% of partners unemployed 58.3% of hh < US$133 pm 53.0% hh food insecurity VAAL REGION BACKGROUND

LIMITATIONS Questionnaires not tested for SA but for Zimbabwe only although in the same region Diarrhea not a public health problem in SA – small sample size 2010 World Cup

Beneficiary profile who completed the study Children between the ages 2 to 13 years of age Experimental group consisted of 29 girls and 32 boys with overall mean age of 6.2 years Control group was 27 girls and 22 boys with overall mean age of 3.5 years 2010 World Cup

RESULTS VariableExperimental group (n=63)‏Control group (n=49)‏ BaselineFollow-upSignificance of change between baseline and follow-up (p)‏ BaselineFollow-upSignificance of change between baseline and follow-up (p)‏ Age6.2±3.66.4±3.53.4±1.23.4±1.1 Weight (kg)‏21.9± ± ± ± Height (m)‏1.14± ± ± ± Skin tenting (seconds)‏ 1.0± ±0.63.2± Nail blanching (seconds)‏ 3.9±0.93.6± ± Handgrip right hand 7.5±4.27.4± Handgrip left hand7.0±4.47.1±

RESULTS: STUNTING (EXPERIMENTAL)‏ ClassificationGirls n= (%)‏ Boys n= (%)‏ Total group n=61 (%)‏ Baseline Severely stunted ≥-3<-2 SDStunted Girls n=25 (%)‏ Boys n=21 (%)‏ Total group n=46 (%)‏ At the end of the intervention (Follow-up)‏ <-3 SDSeverely stunted ≥-3<-2 SDStunted

RESULTS: STUNTING (CONTROL)‏ ClassificationGirls n=27 (%)‏ Boys n=22 (%)‏ Total group n=49 (%)‏ Baseline <-3 SDSeverely stunted ≥-3<-2 SDStunted Girls n=25 (%)‏ Boys n=21 (%)‏ Total group n=46 (%)‏ At the end of the intervention (Follow-up)‏ <-3 SDSeverely stunted ≥-3<-2 SDStunted

RESULTS: UNDERWEIGHT (EXPERIMENTAL)‏ ClassificationGirls n=25 (%)‏ Boys n=23 (%)‏ Total group n=48 (%)‏ Baseline <-3 SDSeverely underweight ≥-3<-2 SDUnderweight Girls n=25 (%)‏ Boys n=21 (%)‏ Total group n=46 (%)‏ At the end of the intervention (Follow-up)‏ <-3 SDSeverely underweight 000 ≥-3<-2 SDUnderweight

RESULTS: UNDERWEIGHT (CONTROL)‏ ClassificationGirls n=25 (%)‏ Boys n=23 (%)‏ Total group n=48 (%)‏ Baseline <-3 SDSeverely underweight ≥-3<-2 SDUnderweight Girls n=25 (%)‏ Boys n=21 (%)‏ Total group n=46 (%)‏ At the end of the intervention (Follow-up)‏ <-3 SDSeverely underweight ≥-3<-2 SDUnderweight

DIARRHEA INCIDENCE RESULTS

DIARRHEA RESULTS: NR OF STOOLS PER DAY

PRODUCT ACCEPTABILITY RESULTS: APPEARANCE

PRODUCT ACCEPTABILITY RESULTS: TEXTURE

PRODUCT ACCEPTABILITY RESULTS: TASTE

CONCLUSIONS MannaPack T consumption results indicated a minority consuming the product for the whole week. A significant improvement was observed for underweight after the intervention. Impact of the MannaPack TM on the nutritional status of the experimental group very clear. This was not observed in the control group.

CONCLUSIONS Incidence and severity of diarrhea significantly reduced in the experimental group as the study progressed. Control group remained largely unchanged. MannaPack TM contributed to the reduced incidence and prevalence of diarrhea in the experimental group.

ACCEPTABILITY RESULTS Mashed potatoes not commonly consumed by the low-income groups in South Africa. MannaPack TM not very acceptable at baseline. Liked the MannaPack TM towards the end of the study.

RECOMMENDATIONS MannaPack TM can be effectively used as a relief food in emergency situations where both diarrhea and/or acute food shortage exist. Can complement the already successful commodities like CSB and WSB in the USAID title II programmes.

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