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      Community mobilization during biofortified orange maize feeding trials in Zambia

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          Abstract

          Abstract. In some societies, studies involving blood draws, oral vaccinations, or supplementation are surrounded by myths and disbeliefs. If not clarified, they may affect study implementation and negatively impact the outcome of well-intended studies from inadequate participation. Through participatory action research, this paper suggests how future trials could be enhanced with reference to community mobilization, drawing from the experience of two interventions in Zambian children with nutritionally enhanced, biofortified orange maize conducted by the National Food and Nutrition Commission and Tropical Diseases Research Center (Zambia), and University of Wisconsin-Madison (USA). The preparatory phase included site visits, signing of a Memorandum of Understanding, equipment inventory, hiring staff, and community meetings. Prior results were shared before the second intervention. After Institutional Review Boards’ approval of procedures, written informed consent was obtained from caregivers. There was overwhelming community participation attributed to the demystification that the project was run by satanists prior to and during the study. Participation led to excellent compliance with 92.8 and 96.4% of subjects completing the final blood draw in 2010 and 2012, respectively. The results of the trials were successfully shared with the district officials and communities from where the study participants were drawn. The positive response by partners and communities, including information sharing, suggests that community mobilization, with the use of varied methods, is effective for full participation of the target groups in feeding trials and would be the case in similar trials if effectively carried out. Community participation in research studies may result in long-term adoption of biofortified foods.

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          Action Research and Minority Problems

          Kurt Lewin (1946)
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            HarvestPlus: Breeding Crops for Better Nutrition

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              Biofortified orange maize is as efficacious as a vitamin A supplement in Zambian children even in the presence of high liver reserves of vitamin A: a community-based, randomized placebo-controlled trial123456

              Background: Biofortification is a strategy to relieve vitamin A (VA) deficiency. Biofortified maize contains enhanced provitamin A concentrations and has been bioefficacious in animal and small human studies. Objective: The study sought to determine changes in total body reserves (TBRs) of vitamin A with consumption of biofortified maize. Design: A randomized, placebo-controlled biofortified maize efficacy trial was conducted in 140 rural Zambian children. The paired 13C-retinol isotope dilution test, a sensitive biomarker for VA status, was used to measure TBRs before and after a 90-d intervention. Treatments were white maize with placebo oil (VA−), orange maize with placebo (orange), and white maize with VA in oil [400 μg retinol activity equivalents (RAEs) in 214 μL daily] (VA+). Results: In total, 133 children completed the trial and were analyzed for TBRs (n = 44 or 45/group). Change in TBR residuals were not normally distributed (P 1 μmol/g, the subtoxicity cutoff; none were <0.1 μmol/g, the deficiency cutoff. The calculated bioconversion factor was 10.4 μg β-carotene equivalents/1 μg retinol by using the middle 3 quintiles of change in TBRs from each group. Serum retinol did not change in response to intervention (P = 0.16) but was reduced with elevated C-reactive protein (P = 0.0029) and α-1-acid glycoprotein (P = 0.0023) at baseline. Conclusions: β-Carotene from maize was efficacious when consumed as a staple food in this population and could avoid the potential for hypervitaminosis A that was observed with the use of preformed VA from supplementation and fortification. Use of more sensitive methods other than serum retinol alone, such as isotope dilution, is required to accurately assess VA status, evaluate interventions, and investigate the interaction of VA status and infection. This trial was registered at clinicaltrials.gov as NCT01814891.
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                Author and article information

                Contributors
                Journal
                vit
                International Journal for Vitamin and Nutrition Research
                Hogrefe AG, Bern
                0300-9831
                1664-2821
                2019
                : 90
                : 3-4
                : 257-265
                Affiliations
                [ 1 ]National Food and Nutrition Commission, Lusaka, Zambia
                [ 2 ]University of Wisconsin-Madison, Madison, USA
                Author notes
                Sherry A. Tanumihardjo, Department of Nutritional Sciences, University of Wisconsin-Madison, 1415 Linden Dr. Madison, WI 53706, USA, E-mail sherry@ 123456nutrisci.wisc.edu
                Article
                vit_90_3-4_257
                10.1024/0300-9831/a000541
                7170181
                30806607
                2facee06-6a87-4fb2-9010-b7d181fde17a
                Distributed under the Creative Commons Attribution 4.0 (Open Access)
                History
                : November 3, 2017
                : May 31, 2018
                Categories
                Original Communication

                Endocrinology & Diabetes,Medicine,Nutrition & Dietetics
                Caregivers,Children,Zambia,Information dissemination,Community participation,Blood draws

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