As we continue to promote research within the DHM, we wanted to take a moment to highlight all of the research projects that Kevin Stephenson, MD, is currently working on. His first project is entitled “Improving Cognition and Gestational duration with targeted NuTrition (COGENT).” Nearly one-quarter of pregnant women in sub-Saharan Africa (SSA) are undernourished, which increases risks for adverse maternal and offspring outcomes, including pre-term birth and impaired offspring cognitive development. Ante- and postpartum depression are underdiagnosed and untreated in many rural SSA settings. This project is a randomized, investigator-blinded, controlled trial with two aims: (1) to determine whether the addition of omega-3 long chain polyunsaturated fatty acids docosahexaenoic acid and eicosapentaenoic acid, as well as choline, to a supplementary food for undernourished pregnant Sierra Leonean women might prolong gestation and improve infant cognitive development compared with a supplementary food without those additions, and (2) to determine whether use of a novel cognitive behavioral therapy program designed for use by illiterate individuals might improve depression among women who develop ante- or postpartum depression during the trial. The trial is ongoing in two rural districts in southern Sierra Leone and has enrolled 300 out of a targeted 1600 participants. This project began in August of 2023, and is expected to continue through 2026.
“Nearly one-quarter of pregnant women in sub-Saharan Africa are undernourished, which increases risks for adverse maternal and offspring outcomes, including pre-term birth and impaired offspring cognitive development.”
Kevin Stephenson, MD
Another project Dr. Stephenson has underway is entitled “Effect of egg powder supplementation on environmental enteric dysfunction and linear growth among rural children in Sierra Leone.” Children with moderate acute malnutrition commonly have impaired gut barrier function and are at high risk for deterioration to severe malnutrition as well as stunted growth, even with treatment. This project is a randomized, investigator-blinded, controlled trial that aims to determine whether daily provision of 15g of egg powder for 6 months to Sierra Leonean children with moderate acute malnutrition might improve small intestinal barrier function, improve linear growth, and reduce deterioration to severe acute malnutrition when compared with an isoenergetic control of corn flour. Longitudinal microbiome and untargeted metabolomic analyses will also be undertaken. This trial is ongoing in Pujehun District, Sierra Leone, and has enrolled 200 of target 400 participants. The timeline of this project is from September of 2023 through 2025.
Dr. Stephenson has also been developing research around a project involving peanut-based school meals in rural Ghana to improve attendance and retention. Ghana’s national school feeding program is limited by implementation failures that are common in rural, impoverished communities in low- and middle-income countries and, at best, provides local staple foods that do not meaningfully improve diet quality. This project includes two trials, one a cluster-randomized, controlled trial and another an individually randomized trial nested within the cluster-randomized trial. Trial 1 aims to determine whether provision of a peanut paste-based school food made with milk powder might improve attendance and reduce dropouts among rural Ghanaian children 5-15y of age when compared with a school food made of local millet/rice flour. Trial 2 aims to determine whether addition of docosahexaenoic acid and choline to the aforementioned peanut paste-based school food for one school year might improve measures of fluid cognition as compared to the same food without these additions. This trial will launch in February if this year and will include 22 schools with a target enrollment of 3,000 children.
“Ghana’s national school feeding program is limited by implementation failures that are common in rural, impoverished communities in low- and middle-income countries and, at best, provides local staple foods that do not meaningfully improve diet quality.”
Kevin Stephenson, MD
Another current research project Dr. Stephenson is working on is entitled “CHoline to Improve Acute Malnutrition and Enhance Cognition (CHIME).” Choline is a nutrient found primarily in animal-source foods and plays myriad roles in human biology, including in 1-carbon metabolism and as a constituent in cell membranes and neurotransmitters. There are no guidelines as to how much choline should be included in therapeutic and supplementary foods used to treat undernourished children. This project is composed of 2 trials. The first is an individually randomized, investigator-blinded, controlled trial that aims to determine whether the addition of a 500mg daily dose of choline to ready-to-use therapeutic food (RUTF) might improve cognitive development among Malawian children 6-59mo of age with severe acute malnutrition as compared with RUTF without added choline. The second is an individually randomized, investigator-blinded, controlled trial that aims to determine whether addition of a 500mg daily dose of choline to ready-to-use supplementary food (RUSF) might reduce rates of deteriorate to severe acute malnutrition among Malawian children 6-59mo of age with moderate acute malnutrition. Trial 1 is ongoing in 4 districts in southern Malawi and has enrolled 100 out of a target 1,500 children. Trial 2 will launch in February 2024.
In addition, Dr. Stephenson is developing a project centered around packaging and processing of food for safety, cost-effectiveness, and reduced environmental impact in Malawi. First, they aim to implement and test the properties and use of a novel biodegradable ready-to-use therapeutic food (RUTF) packaging material at the factory operated by their nutrition group in Malawi. Currently, RUTF packaging material is metalized PET and non-biodegradable and thus environmentally damaging. Second, they aim to design and test solar-powered food processing machines in Malawi for the processing of vegetables, fruits, and legumes in areas with no or unreliable electric grid access. They have corporate partners in the US and Europe for each project component. This project is expected to continue through 2026.