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Abstract The case for the association between aflatoxin exposure in children and stunting is still out. While the few studies that have looked at the association between stunting and aflatoxin exposure have found surprisingly large effects, the results remain inconclusive. The objectives of this study are to: (i) study the impact of reduced aflatoxin exposure on child growth and (ii) identify a package of storage technologies that will reduce aflatoxin contamination. We propose a three arm randomized control trial in which households with children under 2 years of age will be randomly allocated to an intervention group in which a package of storage technology and best practices are provided; an intervention in which maize is tested and contaminated maize is swapped; and a control group in which information on the health effects of aflatoxin and strategies to mitigate it are provided. Aflatoxin levels and stunting rates at baseline and follow up will be compared across the intervention groups to answer the following questions: Does reduced aflatoxin consumption, holding all else constant, improve child growth? What is the effectiveness of a package of low-cost, post-harvest and storage technologies and practices for reducing aflatoxin contamination in household maize stores? Whether the observed association between aflatoxin exposure and stunting in children is causal, and how exposure to this toxin can be mitigated, are open questions. This study comprises a three-arm randomized controlled trial designed to answer both questions. Within 71 randomly selected maize-growing villages of Meru and Tharaka-Nithi counties of Kenya, households that included a pregnant woman or child under 2 years of age were recruited. Villages were randomly assigned to, a post-harvest technology intervention group, an exposure reduction intervention group, or a comparison group. Within the post-harvest group, prices for an aflatoxin mitigation technology were randomly varied across households, as was the opportunity to receive a price incentive for safe stored maize. Primary outcomes in the post-harvest technology sub-study are adoption of the technology and aflatoxin levels in stored maize. Primary outcomes in the exposure reduction sub-study are blood aflatoxin levels in children and child linear growth (LAZ).
Trial End Date October 31, 2016 March 31, 2017
Last Published December 30, 2014 04:22 PM November 23, 2016 01:46 PM
Intervention End Date September 30, 2016 October 31, 2016
Primary Outcomes (End Points) Incidence of household maize stores with aflatoxin levels above 10 ppb; incidence of identification of aflatoxin albumin adduct in blood samples; child anthropometrics Incidence of household maize stores with aflatoxin levels above 10 ppb; willingness to pay for the offered post-harvest technology; incidence of identification of aflatoxin albumin adduct in blood samples; child anthropometrics
Experimental Design (Public) We propose a three arm randomized control trial in which households with children under 2 years of age will be randomly allocated to an intervention group in which a package of storage technology and best practices are provided; an intervention in which maize is tested and contaminated maize is swapped; and a control group in which information on the health effects of aflatoxin and strategies to mitigate it are provided. Aflatoxin levels and stunting rates at baseline and follow up will be compared across the intervention groups to answer the following questions: Does reduced aflatoxin consumption, holding all else constant, improve child growth? What is the effectiveness of a package of low-cost, post-harvest and storage technologies and practices for reducing aflatoxin contamination in household maize stores? We propose a three arm randomized control trial in which 71 villages will be randomly allocated to an intervention group in which a package of storage technology and best practices are provided (post-harvest group); an intervention in which maize is tested and contaminated maize is swapped (aflatoxin exposure reduction group); and a control group in which information on the health effects of aflatoxin and strategies to mitigate it are provided. Within the post-harvest group, prices for an aflatoxin mitigation technology were randomly varied across households, as was the opportunity to receive a price incentive for safe stored maize. The post-harvest sub-study is designed to investigate the effectiveness of a package of low-cost, post-harvest and storage technologies and practices for reducing aflatoxin contamination in household maize stores, and farmers' willingness to pay for such a technology, with and without a price incentive for aflatoxin-safe grain. The exposure reduction sub-study is designed to answer the following research question: does reduced aflatoxin exposure, holding all else constant, improve child growth?
Planned Number of Observations 1500 Households 1852 households
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