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Khan A, Ul-Haq Z, Fazid S, Fatima S, Muhammad N, Ahmed J, Manoharadas S, Safi SZ, Habib I, Garzon C, Ihtesham Y, Zahid F, Dad F, Mahamadou T, Lowe NM. Effectiveness of locally produced ready to use supplementary food on hemoglobin, anthropometrics, and plasma micronutrients concentrations of 6 to 23 months age children: a non-randomized community-based trial from Pakistan. Front Nutr 2023; 10:1176778. [PMID: 37575332 PMCID: PMC10415027 DOI: 10.3389/fnut.2023.1176778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Micronutrient deficiencies including vitamin A, vitamin D, and zinc are highly prevalent in children below 5 years of age in low and -middle-income countries. We aimed to evaluate the effectiveness of ready-to-use Lipid-based Nutrient Supplement-Medium Quantity (LNS-MQ) local name "Wawa-mum" on plasma micronutrient status, hemoglobin concentration and anthropometric measurements. Methods A community-based non-randomized trial was conducted in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019. A total of 110 children aged 6 to 23 months old were recruited and allocated to the intervention and control arm of the study. A total of 57 children in the intervention arm received a daily ration of 50 g of Wawa-mum, for one year. To assess the impact of the intervention on primary outcome measures, i.e., serum vitamin A, D concentration, plasma zinc, and hemoglobin concentration. Blood samples were collected at baseline and after one year following the intervention. The vitamins concentration in serum were assessed using Enzyme-Linked Immunosorbent Assay (ELISA) and plasma zinc by atomic absorption spectrometry. The hemoglobin concentration was measured by an automated hematology analyzer. A 24-h dietary recall interview was used to assess the nutrient intake adequacy. Multivariate Linear regression models were used to analyze the outcomes while controlling for potential confounders. Results In the intervention arm, children had on average 6.2 μg/dL (95% CI 3.0-9.3, value of p<0.001) increase in the serum vitamin A concentration, 8.1 ng/mL (95% CI 1.3-14.9, value of p 0.02) increase in serum vitamin D concentration and 49.0 μg/dL (95% CI 33.5-64.5, value of p<0.001) increase in the plasma zinc concentration, and 2.7 g/dL (95% CI 2.0-3.3, value of p<0.001) increase in hemoglobin concentration while adjusted for covariates. An addition, length-for-age z-score (LAZ), weight-for-length z-score (WLZ), weight-for-age z-score (WAZ), and prevalence of undernutrition including stunting, wasting, and underweight were calculated as a secondary outcome to investigate the impact of micronutrients on growth parameters, that has been improved significantly after receiving the Wawa-mum. Conclusion Wawa-mum (LNS-MQ) is an effective intervention to improve the micronutrient status, hemoglobin concentration, and growth parameters in 6 to 23 months children, which can be scaled up in the existing health system to address the alarming rates of under nutrition in Pakistan and other developing countries. Clinical trial registration https://doi.org/10.1186/ISRCTN94319790, ISRCTN94319790.
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Affiliation(s)
- Aslam Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zia Ul-Haq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sheraz Fazid
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Sadia Fatima
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Nawshad Muhammad
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Jawad Ahmed
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Salim Manoharadas
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Sher Zaman Safi
- Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Malaysia
- Interdisciplinary Research Center in Biomedical Materials, COMSATS University Islamabad Lahore Campus, Lahore, Pakistan
| | - Ijaz Habib
- World Food Programme, Peshawar, Pakistan
| | | | | | | | - Fazal Dad
- World Food Programme, Peshawar, Pakistan
| | | | - Nicola M. Lowe
- UCLan Research Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
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Zaidi S, Das JK, Khan GN, Najmi R, Shah MM, Soofi SB. Food supplements to reduce stunting in Pakistan: a process evaluation of community dynamics shaping uptake. BMC Public Health 2020; 20:1046. [PMID: 32616009 PMCID: PMC7331235 DOI: 10.1186/s12889-020-09103-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background There is an increasing interest in use of food supplements to prevent childhood stunting, however the evidence on the process indicators is scarce. We in this study explore the barriers to the effective implementation of food supplementation programs and the possible mitigation strategies which can guide the design of future programs. Methods We undertook a process evaluation of a stunting prevention food supplementation pilot program in rural Pakistan that distributed Wheat Soy Blend (WSB) to pregnant & lactating women, and Lipid-based Nutrient Supplement (LNS) and micronutrient powder (MNP) to < 5 years children. We used a mixed methods approach through a quantitative survey of 800 households and conducted 18 focused group discussion (FGDs) (with male and female caregivers), 4 FGDs (with Community Health Workers (CHWs)) and 22 key informant interviews (with district stakeholders) to evaluate the community side factors affecting uptake through five parameters: value, acceptability, receipt of supplement, usage and correct dosage. Results The findings show that proportionately few beneficiaries consumed the full dose of supplements, despite reasonable knowledge amongst caregivers. Sharing of supplements with other household member was common, and the full monthly stock was usually not received. Qualitative findings suggest that caregivers did not associate food supplements with stunting prevention. WSB was well accepted as an extra ration, LNS was popular due its chocolaty taste and texture, whereas MNP sprinkles were perceived to be of little value. The cultural food practices led to common sharing, whereas interaction with CHWs was minimal for nutrition counselling. Qualitative findings also indicate CHWs related programmatic constraints of low motivation, multi-tasking, inadequate counselling skills and weak supervision. Conclusion We conclude that the community acceptability of food supplements does not translate into optimal consumption. Hence a greater emphasis is needed on context specific demand creation and focusing on the supply side constraints with improved logistical planning, enhanced motivation and supervision of community workers with involvement of multiple stakeholders. While, similar studies are needed in varying contexts to help frame universal guidelines. Trial registration ClinicalTrials.gov Identifier: NCT02422953. Registered on April 22, 2015.
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Affiliation(s)
- Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. .,Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Jai K Das
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rabia Najmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mashal Murad Shah
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sajid B Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Goyena EA, Barba CVC, Talavera MTM, Paunlagui MM, Rola AC, Tandang NA. Acceptance and Compliance With Micronutrient Powder and Complementary Food Blend Use by Filipino Mothers and Their Promotion by Community Workers. Food Nutr Bull 2019; 40:202-220. [PMID: 30866669 DOI: 10.1177/0379572119833853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the nationwide micronutrient powder (MNP) supplementation, the Philippines only saw limited success in reducing the prevalence of anemia-a condition that has remained a public health concern among young children. OBJECTIVE To assess and explore the acceptability and compliance to MNP and Bigas-Mongo (BigMo) complementary food blend among mothers/caregivers of children aged 6 to 23 months and the promotion of these products by community health workers (CHWs). METHODS This study was part of the randomized controlled trial involving 3 methods of data collection: (1) bimonthly visits to mothers and caregivers for 6 months to determine the level of acceptability and compliance of the 4 intervention groups; (2) initial and final interviews with mothers/caregivers (initial = 141; final = 130) to gather their experiences and difficulties in MNP and BigMo preparation and feeding; and (3) focus group discussion (n = 4) among CHWs (n = 13) to understand their perceptions and difficulties in promoting MNP and BigMo. RESULTS The overall compliance to MNP consumption was 74.7%, with some difference between the groups. Analysis of the information received from mothers/caregivers showed that maternal adaptive strategies in preparing and feeding MNP to their children could affect MNP use, while nonreceptiveness of mothers to integrating MNP into the child's feeding routine, perceived side effects, and perceived unfavorable taste and smell were key factors considered to limit MNP use. CONCLUSION This study provides insights into MNP and BigMo acceptability and compliance by mothers and their promotion by CHWs, which may be useful in improving MNP program and complementary feeding projects and programs in similar settings.
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Affiliation(s)
- Eva A Goyena
- 1 Department of Science and Technology, Food and Nutrition Research Institute, Taguig, Philippines
| | - Corazon V C Barba
- 2 Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines, Los Banos, Philippines
| | - Ma Theresa M Talavera
- 2 Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines, Los Banos, Philippines
| | - Merlyne M Paunlagui
- 3 Institute for Governance and Rural Development, College of Public Affairs, University of the Philippines, Los Banos, Philippines
| | - Agnes C Rola
- 3 Institute for Governance and Rural Development, College of Public Affairs, University of the Philippines, Los Banos, Philippines
| | - Nancy A Tandang
- 4 Institute of Statistics, College of Arts and Sciences, University of the Philippines, Los Banos, Philippines
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Huey SL, Venkatramanan S, Udipi SA, Finkelstein JL, Ghugre P, Haas JD, Thakker V, Thorat A, Salvi A, Kurpad AV, Mehta S. Acceptability of Iron- and Zinc-Biofortified Pearl Millet (Dhanashakti)-Based [corrected] Complementary Foods among Children in an Urban Slum of Mumbai, India. Front Nutr 2017; 4:39. [PMID: 28971097 PMCID: PMC5609630 DOI: 10.3389/fnut.2017.00039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/31/2017] [Indexed: 12/04/2022] Open
Abstract
Biofortification, a method for increasing micronutrient content of staple crops, is a promising strategy for combating major global health problems, such as iron and zinc deficiency. We examined the acceptability of recipes prepared using iron- and zinc-biofortified pearl millet (FeZnPM) (~80 ppm Fe, ~34 ppm Zn, varietal ICTP-8203), compared to conventional pearl millet (CPM) (~20 ppm Fe, ~19 ppm Zn) in preparation for an efficacy trial. Our objective was to examine the acceptability of FeZnPM compared to CPM among young children and mothers living in the urban slums of Mumbai. Standardized traditional feeding program recipes (n = 18) were prepared with either FeZnPM or CPM flour. The weight (g) of each food product was measured before and after consumption by children (n = 125) and the average grams consumed over a 3-day period were recorded. Mothers (n = 60) rated recipes using a 9-point hedonic scale. Mean intakes and hedonic scores of each food product were compared using t-tests across the two types of pearl millet. There were no statistically significant differences in consumption by children (FeZnPM: 25.27 ± 13.0 g; CPM: 21.72 ± 6.90 g) across the food products (P = 0.28). Overall mean hedonic scores for all recipes were between 7 to 9 points. CPM products were rated higher overall (8.22 ± 0.28) compared to FeZnPM products (7.95 ± 0.35) (P = 0.01). FeZnPM and CPM were similarly consumed and had high hedonic scores, demonstrating high acceptability in this population. These results support using these varieties of pearl millet in a proposed trial [http://Clinicaltrials.gov ID: NCT02233764; Clinical Trials Registry of India (CTRI), reference number REF/2014/10/007731, CTRI number CTRI/2015/11/006376] testing the efficacy of FeZnPM for improving iron status and growth.
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Affiliation(s)
- Samantha Lee Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Sudha Venkatramanan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Shobha A Udipi
- Department of Food Science and Nutrition, SNDT Women's University, Mumbai, India
| | - Julia Leigh Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States.,St. John' Research Institute, Division of Nutrition, Bangalore, India.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, United States
| | - Padmini Ghugre
- Department of Food Science and Nutrition, SNDT Women's University, Mumbai, India
| | - Jere Douglas Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Varsha Thakker
- Department of Food Science and Nutrition, SNDT Women's University, Mumbai, India
| | - Aparna Thorat
- Department of Food Science and Nutrition, SNDT Women's University, Mumbai, India
| | - Ashwini Salvi
- Department of Food Science and Nutrition, SNDT Women's University, Mumbai, India
| | - Anura V Kurpad
- St. John' Research Institute, Division of Nutrition, Bangalore, India
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States.,St. John' Research Institute, Division of Nutrition, Bangalore, India.,Institute for Nutritional Sciences, Global Health, and Technology (INSiGHT), Cornell University, Ithaca, NY, United States
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5
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Christian P, Shaikh S, Shamim AA, Mehra S, Wu L, Mitra M, Ali H, Merrill RD, Choudhury N, Parveen M, Fuli RD, Hossain MI, Islam MM, Klemm R, Schulze K, Labrique A, de Pee S, Ahmed T, West KP. Effect of fortified complementary food supplementation on child growth in rural Bangladesh: a cluster-randomized trial. Int J Epidemiol 2015; 44:1862-76. [PMID: 26275453 PMCID: PMC4689999 DOI: 10.1093/ije/dyv155] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting. METHODS A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy'doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < -2), weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year. RESULTS Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpy'doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy'doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5-6% (P ≤ 0.01) in those receiving Plumpy'doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27-0.30 cm and 0.07-0.10 (all P < 0.05), respectively, in all four food groups relative to the control. CONCLUSIONS In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.
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Affiliation(s)
- Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
| | - Saijuddin Shaikh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, JiVitA Project, Gaibandha, Bangladesh
| | | | - Sucheta Mehra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maithilee Mitra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hasmot Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, JiVitA Project, Gaibandha, Bangladesh
| | - Rebecca D Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nuzhat Choudhury
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Monira Parveen
- United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and
| | - Rachel D Fuli
- United Nations World Food Programme, IDB Bhaban, Dhaka, Bangladesh and
| | - Md Iqbal Hossain
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Md Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Rolf Klemm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kerry Schulze
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saskia de Pee
- Office of Nutrition Advisor, United Nations World Food Programme, Rome, Italy
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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