Protein Energy Malnutrition (PEM) and iron deficiency Anemia (IDA) affect children
below five years globally. Studies in Kenya show levels of stunting (26%), wasting
(4%), underweight (11%) and low iron intakes (7%) among children aged 6-23
months. These children are at critical period of rapid growth marked by malnutrition
which can be irreversible if not effectively addressed. The standard CSB to manage
PEM is inadequate in energy and micronutrients. Spirulina powder is richer in
proteins and iron than soya bean and if used to fortify CSB would provide a more
energy dense and iron rich flour than standard CSB. The SCSB can be produced
locally by households to ensure nutritious consumption for under-nourished children
than CSB. The objective of the study was to determine impact of SCSB on PEM and
IDA among children aged 6-23 months in Ndhiwa Sub-County through a randomized
controlled trial. A total of 240 children with PEM and IDA were accessed at Ndhiwa
Sub-County Hospital and randomly assigned to two experimental groups (EG1
received SCSB while EG2 received standard CSB) and one control group who did not
receive any treatment during the intervention. Data was collected using a
questionnaire and a Focus Group Discussion (FGD) guide. PEM was assessed using
the following indicators; plasma Retinol Binding Protein, WHZ and WAZ scores
while iron status assessed based on Hematocrit levels. Relative Risk, Difference in
Difference and Log-rank tests were used to compare impact of SCSB and standard
CSB on PEM and IDA while logistic regression used to identify predictors of plasma
RBP, Hct levels, WHZ and WAZ. At baseline, assessment of plasma RBP and Hct
levels was done. In addition nutrient content analysis of spirulina powder, SCSB,
CSB and maize flours was done for carbohydrates, proteins, fats and iron, and
production of SCSB and CSB flours used in the intervention. Intervention was done
for 6 months and involved daily consumption of 100g SCSB and CSB flours while
doing assessments of key variables up to six months. The SCSB was significantly
higher in energy (5.4±0.1Kcal/100g vs 2.9±0.7 and 2.8±0.3, p=0.036), protein
(20.84±0.2 vs 15.47±0.2 and 0.06±0.1, p=0.043) and iron (15.32±0.2 vs 6.15±0.3 and
0.81±0.2, p=0.043) than CSB and maize meal. The children who consumed SCSB
significantly improved in RBP status (RR:3.07;CI:2.62-2.72,p=0.004 and
RR:4.06;CI:3.63-3.76,p=0.0001), Hct status (RR: 3.15;CI:1.91-2.07,p=0.002 and
RR:4.07;CI:3.66-3.79,p<0.0001), wasting (RR:3.10;CI:0.001-0.48,p=0.0001 and
RR:4.08;CI:3.37-3.58,p=0.0001) and underweight (RR: 3.16;CI:3.58-3.91,p=0.0001
and RR:4.18;CI:3.05-3.27,p=0.0001) compared to children who consumed CSB and
those in control group. The children who consumed SCSB had faster recovery from
PEM and IDA compared to children who consumed CSB and children in control
group. The breast fed children consuming SCSB were significantly meeting RDAs for
energy (913.8±149Kcal vs 727.8±125 and 654±114,p=0.011 ), protein (15.2±8g vs
8.9±3 and 8.2±2, p=0.004) and iron (15.9±0.3mg vs 6.0±0.7 and 4.3±0.8, p=0.004) as
well as non-breastfed; energy (832±116Kcal vs 781±93 and 652±102, p=0.022),
protein (19.9±8 vs 8.3±3 and 6.2±4, p=0.001) and iron (15.9±0.1 vs 7.1±0.2 and
4.9±0.6, p=0.002) compared to children who consumed CSB and those in control
group. There were no significant difference in the acceptability attributes of
mothers/caregivers of children who consumed both SCSB and CSB porridges (chisquare:
p>0.005). The SCSB had a significantly higher impact on PEM and iron
deficiency than standard CSB and control group. The use of spirulina powder as a
fortifier for commonly consumed cereals in Kenyan communities is recommended.