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Zavala E, Rahman A, Kalbarczyk A, de Boer M, Khaled N, Chakraborty B, Rahman H, Ali H, Haque R, Ayesha K, Siddiqua TJ, Afsana K, Christian P, Thorne-Lyman AL. Acceptability of a balanced energy protein (BEP) supplement for pregnant women in Bangladesh. Matern Child Nutr 2023:e13587. [PMID: 37991138 DOI: 10.1111/mcn.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small-for-gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready-to-eat fortified BEP product among women of reproductive age and their health care providers (HCPs) in rural Bangladesh and explored the feasibility of adhering to daily supplementation. We implemented a formative study using focus groups discussions with women (n = 29) and HCPs (n = 17) to introduce the product and investigate components of acceptability. A "trials of improved practice" activity was conducted in subset of women (n = 16) to evaluate adherence to BEP over a 2-week period, followed by focus group discussions to identify challenges with adherence and strategies employed. Contributors to BEP acceptability included the product's sensory attributes, such as taste, smell and texture; the attractive packaging and informative labelling; and the perceived benefits of use. Participants also identified household and community level factors influencing the adoption of BEP, such as trust in the provider, cultural beliefs on supplement use in pregnancy, and family member tasting and approval. Over the 2-week period, women consumed over 80% of the supplements provided to them and identified strategies for adherence, including visual aids and reminders from family members or providers. HCPs recommended targeted communication messages for mothers-in-law to foster a supportive home environment. Findings informed changes to the BEP product to improve acceptability and shaped the content of communication messages to optimise adherence in a forthcoming effectiveness trial.
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Affiliation(s)
- Eleonor Zavala
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Atiya Rahman
- Humanitarian Hub, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Anna Kalbarczyk
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mary de Boer
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nazrana Khaled
- Humanitarian Hub, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Barnali Chakraborty
- Humanitarian Hub, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Hafizur Rahman
- The JiVitA Maternal and Child Health and Nutrition Research Project, Rangpur, Bangladesh
| | - Hasmot Ali
- The JiVitA Maternal and Child Health and Nutrition Research Project, Rangpur, Bangladesh
| | - Rezwanul Haque
- The JiVitA Maternal and Child Health and Nutrition Research Project, Rangpur, Bangladesh
| | - Kaniz Ayesha
- The JiVitA Maternal and Child Health and Nutrition Research Project, Rangpur, Bangladesh
| | - Towfida J Siddiqua
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- The JiVitA Maternal and Child Health and Nutrition Research Project, Rangpur, Bangladesh
| | - Kaosar Afsana
- Humanitarian Hub, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew L Thorne-Lyman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Lama TP, Khatry SK, Isanaka S, Moore K, Jones L, Bedford J, Katz J, de Pee S, LeClerq SC, Tielsch JM. Acceptability of 11 fortified balanced energy-protein supplements for pregnant women in Nepal. Matern Child Nutr 2022; 18:e13336. [PMID: 35263004 PMCID: PMC9218317 DOI: 10.1111/mcn.13336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 06/01/2023]
Abstract
Evidence suggests that multiple micronutrient and balanced energy protein (BEP) supplementation during pregnancy can decrease the risk of stillbirth and small-for-gestational-age births and increase birth weight. We conducted a mixed-methods formative research study to identify the most acceptable among a range of 11 candidates fortified BEP supplements for use in pregnancy and lactation in a rural district in Nepal. Forty pregnant women aged 15-40 years participated in a test meal tasting of 11 different sweet and savoury candidate BEP supplements. Each participant rated the products on organoleptic properties using a 7-point hedonic scale (1 = Dislike it very much to 7 = Like it very much), ranked her 'top 3' most liked supplements, and subsequently discussed each product with peers in focus group discussions (FGDs). Five supplements (sweet lipid-based nutrient supplement (LNS), savoury LNS, sweet vanilla biscuits, vanilla instant drinks and seasoned pillows) achieved the maximum overall median hedonic score of 7, with sweet LNS and seasoned pillows ranking as the top 2. This was consistent with the assessments in FGDs. Women in the FGDs expressed dislike of the smell and taste of the cocoa drink, savoury masala bar, sweet mango bar and savoury curry biscuit, which was consistent with the hedonic scale scores. This study provides valuable insights into our understanding of women's acceptance of different BEP supplements during pregnancy in rural Nepal and has helped identify the two most accepted BEP supplements to be used in a two-month home trial to assess utilisation and compliance in this setting.
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Affiliation(s)
- Tsering P. Lama
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Subarna K. Khatry
- Nepal Nutrition Intervention Project – Sarlahi (NNIPS)KathmanduNepal
| | - Sheila Isanaka
- Departments of Nutrition and Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | | | | | | | - Joanne Katz
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Saskia de Pee
- Department of Global Health, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Steven C. LeClerq
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Nepal Nutrition Intervention Project – Sarlahi (NNIPS)KathmanduNepal
| | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
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