Pawpaw seed-fortified porridge has a significant effect expelling roundworms from children, and its application as a routine school meal may aid current national school-based nutrition and worming programmes in Africa.
In a new study, researchers found that pawpaw seed- fortified porridge had a better nutritional outcome and effect on child fungal infections than albendazole; the conventional worm expeller children are often served.
The researchers designed maize (corn) flour fortified with ground dried pawpaw seeds and used it to prepare porridge. Maize, millet and pawpaw seeds were mixed in a ratio of 5:1:2.5 and ground together into a flour using a hammer mill.
Micronutrient fortification was then added at an inclusion rate of 0.25 per cent. Porridge was prepared by heating water up to boiling and adding the product, stirring for some minutes then adding sugar. Each child received 300 ml of the porridge every day, constituting a dose of 10 g of the pawpaw seeds per child per day.
Porridge made from maize flour is one of the most prevalent traditional school meal snacks in developing countries. Because of its low cost and popularity in schools, the World Food Programme has adopted it as a component in school meals and it is often prepared and given as a snack at break time.
Micronutrients have also been linked to reduced parasite infestation and re-infection in endemic areas.
Children age between four and 12 years from three primary schools from Nandi County in Kenya were randomised into three arms. One school received 300 ml pawpaw fortified porridge daily (pawpaw group).
The second school received a similar serving of plain porridge without the pawpaw ingredient (control group) and the third school received plain porridge and the conventional MDA approach of one time 400 mg dosage of albendazole (albendazole arm).
At the beginning and the end of this clinical trial carried out from May to August 2015, participants were assessed for the presence of ringworms and other skin infections. Also, anthropometric measurements (weight and height) and haemoglobin levels were taken from each participating child.
Infections by intestinal worms including the soil-transmitted worms such as giant roundworm, hookworm, whipworm, and schistosomiasis are an important public health concern. The burden of these infections is highest among school-aged children.
At the onset of the study, the prevalence of parasitic infection was 49 per cent with 80 per cent of the infected children exhibiting infestation by giant roundworm. The 2018 study was published in BMC Complementary and Alternative Medicine.
Both the pawpaw group and the control group exhibited a significantly lower prevalence of ringworm infection after the eight weeks treatment period compared to baseline.
The overall egg reduction rate of fortified porridge treatment and albendazole was 63.9 and 78.8 per cent respectively. But the albendazole group had a significant increase in the prevalence of ringworm during follow-up compared to baseline.
There was, however, no evidence on its efficacy on hookworms and whipworms, two of the most prevalent and devastating intestinal parasites infecting children in developing countries.
Moreover, consumption of the papaya seed-fortified porridge resulted in reduced cases of anaemia and lower infection rates for ringworms.
According to the researchers, the increase in haemoglobin levels in both the pawpaw and albendazole groups can be attributed mostly to the micronutrient fortification.
“This is because the only parasite found to be prevalent in the region was roundworm, which is usually not responsible for causing iron deficiency anaemia.
“Integration of worming with micronutrient supplementation hence may provide a significant boost to improved child health status.
“Our preliminary results imply that a school porridge meal composed with pawpaw seeds may be considered as an alternative mass drug administration (MDA) strategy or a supplement for the large-scale worming of school children,” they declared.
Howbeit, they said further studies are still required to determine the minimal effective dose to inform on future cost reduction strategies in the event that the fortified meal approach is confirmed as a feasible school-based worming strategy.
Moreover, consumption of the pawpaw seed-fortified porridge resulted in reduced cases of anaemia and lower infection rates for ringworms.
The reduction in roundworm intensity is consistent with previous studies where dried seeds of pawpaw were used to eliminate intestinal parasites.
A 2007 study in the Journal of Medicine Food showed that children who received 1 g honey-emulsified dose of pawpaw seeds showed a parasite clearance rate of 77 per cent after seven days as compared to 17 per cent clearance rate on those who were given honey alone.
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