The purpose of this study is to determine the health impacts of consistent consumption of insect-fortified crackers among school-aged children in Madagascar. Specifically, in this RCT, the investigators will assess whether the insect-fortified crackers can improve the health status of Malagasy school children. The investigators' objectives are to: (1) Assess changes in gut microbiome composition that occur after 6 and 14 weeks of cracker consumption through 16S rRNA sequencing. (2) Assess changes in intestinal and systemic inflammation after 6 and 14 weeks of cracker consumption through quantification of fecal calprotectin, lactoferrin, myeloperoxidase (MPO), and alpha-1-antitrypsin (AAT) and circulating pro-inflammatory cytokines. (3) Assess changes in iron status after 14 weeks of cracker consumption through quantification of hemoglobin (Hb), inflammation-adjusted serum ferritin, and soluble transferrin receptor (sTfR).
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Gut mircrobiome
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Iron via soluble transferrin receptor
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Intestinal inflammation via calprotectin
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Intestinal inflammation via lactoferrin
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Intestinal inflammation via lipocalin
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Intestinal inflammation via anlpha-1 antitrypsin
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Intestinal inflammation via myeloperoxidase
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Systemic inflammation via quantification of circulating cytokines
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Iron via quantification of hemoglobin
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.
Iron via inflammation adjusted ferritin
Timeframe: From enrollment to the end of treatment after 14 weeks of cracker consumption.