Patterns and determinants of small-quantity LNS utilization in rural Malawi and Mozambique: considerations for interventions with specialized nutritious foods

Maternal and Child Nutrition

Volumn 13, Issue 1, 2017, Pages

  Kodish, Stephen R ^a   Aburto, Nancy J ^b   Nseluke Hambayi, Mutinta ^c   Dibari, Filippo ^d   Gittelsohn, Joel ^a  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^b World Food Programme   (Italy)

^c United Nations World Food Programme   (Malawi)

^d World Food Programme   (Mozambique)

Author keywords

formative research; infant and young child feeding (IYCF) practices; intra household sharing practices; qualitative research; small quantity lipid based nutrient supplements (SQ LNS)

Indexed keywords

ARTICLE; CHILD HEALTH; CHILD NUTRITION; DIET SUPPLEMENTATION; DIETARY INTAKE; DIETARY SUPPLEMENT; FEEDING BEHAVIOR; FEMALE; FOOD AVAILABILITY; FOOD STORAGE; HEALTH CARE UTILIZATION; HUMAN; INFANT; MALAWI; MOZAMBIQUE; NUTRITIONAL ASSESSMENT; NUTRITIONAL STATUS; PRIORITY JOURNAL; RURAL AREA; SMALL QUANTITY LIPID BASED NUTRIENT SUPPLEMENT; SOCIAL SUPPORT; CLINICAL TRIAL; DIET; FAMILY SIZE; INFANT NUTRITION; MALE; METHODOLOGY; MULTICENTER STUDY; QUESTIONNAIRE; RURAL POPULATION; SUPPLY AND DISTRIBUTION; UTILIZATION;

DIET; DIETARY SUPPLEMENTS; FAMILY CHARACTERISTICS; FEEDING BEHAVIOR; FEMALE; HUMANS; INFANT; INFANT NUTRITIONAL PHYSIOLOGICAL PHENOMENA; MALAWI; MALE; MOZAMBIQUE; NUTRITIONAL STATUS; RESEARCH DESIGN; RURAL POPULATION; SURVEYS AND QUESTIONNAIRES;

EID: 84955100963     PISSN: 17408695     EISSN: 17408709     Source Type: Journal    
DOI: 10.1111/mcn.12234     Document Type: Article

References (68)

1. Abbeddou S., Hess S.Y., Yakes J.E., Somé J.W., Vosti S.A., Guissou R.M. et al. (2015) Comparison of methods to assess adherence to small-quantity lipid-based nutrient supplements (SQ-LNS) and dispersible tablets among young Burkinabé children participating in a community-based intervention trial. Maternal & Child Nutrition. DOI: 10.1111/mcn.12162.
2. Adu-Afarwuah S., Lartey A., Brown K.H., Zlotkin S., Briend A. & Dewey K.G. (2007) Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. American Journal of Clinical Nutrition 86, 412–420.
3. Adu-Afarwuah S., Lartey A., Zeilani M. & Dewey K.G. (2011) Acceptability of lipid-based nutrient supplements (LNS) among Ghanaian infants and pregnant or lactating women. Maternal & Child Nutrition 7, 344–356.
4. Ahmed T., Hossain M. & Sanin K.I. (2012) Global burden of maternal and child undernutrition and micronutrient deficiencies. Annals of Nutrition & Metabolism 61 (Suppl.1), 8–17.
5. Allen L.H. (2002) Iron supplements: scientific issues concerning efficacy and implications for research and programs. The Journal of Nutrition 132 (4), 813S–819S.
6. Arimond M., Zeilani M., Jungjohann S., Brown K.H., Ashorn P., Allen L.H. et al. (2013) Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project. Maternal & Child Nutrition, 1–31.
7. Ashorn U., Alho L., Arimond M., Dewey K.G., Maleta K., Phiri N. et al. (2015) Malawian mothers consider lipid-based nutrient supplements acceptable for children throughout a 1-year intervention, but deviation from user recommendations is common. Journal of Nutrition. DOI: 10.3945/jn.114.209593.
8. Bernard H.R. (2006) Research Methods in Anthropology, 2nd edn. Sage Publications, Inc.: Thousand Oaks, CA.
9. Bhutta Z.A., Das J.K., Rizvi A., Gaffey M.F., Walker N., Horton S. et al. (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382, 452–477.
10. Black R.E., Victoria C.G., Walker S.P., Bhutta Z.A., Christian P., de Onis M. et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427–451.
11. Bonvecchio, A., Pelto, G.H., Escalante, E., Monterrubio, E., Habicht, J.P., Nava, F. et al. (2007) Maternal knowledge and use of a micronutrient supplement was improved with a programmatically feasible intervention in Mexico. The Journal of Nutrition 137 (2), 440–446.
12. Charmaz K. (2006) Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage Publications: London.
13. Cohuet S., Marquer C., Shepherd S., Captier V., Langendorf C., Ale F. et al. (2012) Intra-household use and acceptability of ready-to-use-supplementary-foods distributed in Niger between July and December 2010. Appetite 59, 698–705.
14. Davis T.E., Fischer E.F., Rohloff P.J. & Heimburger D.C. (2014) Chronic malnutrition, breastfeeding, and ready to use supplementary food in a Guatemalan Maya town. Human Organization 73, 72–81.
15. Dettwyler K.A. (1989) Styles of infant feeding: parental/caretaker control of food consumption in young children. American Anthropology 9, 696–703.
16. Dewey K.G. & Arimond M. (2012) Lipid-based nutrient supplements: how can they combat child malnutrition? PLoS Medicine. DOI: 10.1371/journal.pmed.1001314.
17. Dewey K.G., Yang Z. & Boy E. (2009) Systematic review and meta-analysis of home fortification of complementary foods. Maternal & Child Nutrition 5, 283–321.
18. Demographic and Health Survey [DHS] (2010) Malawi Demographic and Health Survey. [Online] Available at: http://dhsprogram.com/pubs/pdf/FR247/FR247.pdf (Accessed 13 June 2014).
19. Demographic Health Survey [DHS] (2011) Mozambique DHS—final report (Portuguese). [Online] Available at: http://www.measuredhs.com/publications/publication-FR266-DHS-Final-Reports.cfm (Accessed 1 May 2014).
20. De-Regil L.M., Suchdev P.S., Vist G.E., Walleser S. & Pena-Rosas J.P. (2013) Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (review). Evidence-Based Child Health: A Cochrane Review Journal 8 (1), 112–201.
21. Fabrizio C.S., van Liere M. & Pelto G. (2014) Identifying determinants of effective complementary feeding behavior change interventions in developing countries. Maternal & Child Nutrition 10, 575–592. DOI: 10.1111/mcn.12119.
22. Flax V.L., Thakwalakwa C., Phuka J., Ashorn U., Cheung Y.B., Maleta K. et al. (2009) Malawian mothers' attitudes towards the use of two supplementary food for moderately malnourished children. Appetite 53, 195–202.
23. Flax V.L., Phuka J., Cheung Y.B., Ashorn U., Maleta K. & Ashorn P. (2010) Feeding patterns and behaviors during home supplementation of underweight Malawian children with lipid-based nutrient supplements or corn-soy blend. Appetite 54, 504–511.
24. Gittelsohn J. (1991) Opening the box: intrahousehold food distribution in rural Nepal. Social Science & Medicine 33 (10), 1141–1154. DOI: 10.1016/0277-9536(91)90230-A.
25. Gittelsohn J., Shankar A.V., Ram R., Gnywali T. & West K.P. (1997) Estimating reactivity and its effects in direct observation studies of health behavior. Human Organization 56 (2), 182–189.
26. Gittelsohn J., Shankar A.V., West K.P., Faruque F., Gnywali T. & Pradhan E.K. (1998) Child feeding and care behaviors are associated with xeropthalmia in rural Nepalese households. Social Science and Medicine 47 (4), 477–486.
27. Glaser B. & Strauss A. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, NY: Aldine de Gruyter.
28. Haddad L. & Kanbur R. (1992) The value of intra-household survey data for age-based nutritional targeting. Annales d'Economie et de Statistique 29, 65–81.
29. Hess S.Y., Bado L., Aaron G.J., Ouedraogo J.B., Zeilani M. & Brown K.H. (2011) Acceptability of zinc-fortified, lipid-based nutrient supplements (LNS) prepared for young children in Burkina Faso. Maternal & Child Nutrition 7, 357–367.
30. Hess S.Y., Abbeddou S., Jimenez E.Y., Somé J.W., Vosti S.A., Ouédraogo Z.P. et al. (2015) Small-quantity lipid-based nutrient supplements, regardless of their zinc content, increase growth and reduce the prevalence of stunting and wasting in young Burkinabe children: a cluster-randomized trial. PLoS ONE 10 (3). DOI: 10.1371/journal.pone.0122242.
31. Home Fortification Technical Advisory Group (HF-TAG) (2013) Monitoring manual for developing and implementing monitoring systems for home fortification interventions. HF-TAG: Geneva.
32. Ickes S.B., Jilcott S.B., Myhre J.A., Adair L.S., Thirumurthy H., Handa S. et al. (2012) Examination of facilitators and barriers to home-based supplemental feeding with ready-to-use-food for underweight children in western Uganda. Maternal & Child Nutrition 8, 115–129.
33. Inayati D.A., Scherbaum V., Purwestri R.C., Wirawan N.N., Suryantan J., Hartono S. et al. (2012) Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia. Asia Pacific Journal of Nutrition 21 (3), 361–373.
34. Jefferds M.E., Irizarry L., Timmer A. & Tripp K. (2013) UNICEF–CDC global assessment of home fortification interventions 2011: current status, new directions, and implications for policy and programmatic guidance. Food and Nutrition Bulletin 34 (4), 434–443.
35. Kigutha H.N. (1997) Assessment of dietary intake in rural communities in Africa: experiences in Kenya. American Journal of Clinical Nutrition 65, 1168–1172.
36. Kitanichi K. (2000) The Aka and Baka: food sharing among two central Africa hunter-gatherers [Online]. Senri Ethnological Studies 53, 149–169. Available at: http://camel.minpaku.ac.jp/dspace/bitstream/10502/907/1/SES53_008.pdf (Accessed 5 June 2014)
37. Kodish S., Aburto N., Nseluke H.M., Kennedy C. & Gittelsohn J. (2015a) Identifying the sociocultural barriers and facilitating factors to nutrition-related behavior change: formative research for a stunting prevention program in Ntchisi, Malawi. Food and Nutrition Bulletin 36 (2), 138–153.
38. Kodish S., Aburto N., Dibari F., Brieger W., Agostinho S.P. & Gittelsohn J. (2015b) Informing a behavior change communication strategy: formative research findings from the scaling up nutrition (SUN) movement in Mozambique. Food and Nutrition Bulletin 36 (3), 354–370.
39. Kodish S., Rah J.H., Kraemer K., de Pee S. & Gittelsohn J. (2011) Understanding low usage of micronutrient powder in the Kakuma Refugee Camp, Kenya: findings from a qualitative study. Food and Nutrition Bulletin 32 (3), 292–303.
40. Kreuter M.W., Lukwago S.N., Bucholtz D.C., Clark E.M. & Sanders-Thompson V. (2003) Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Education & Behavior 30 (2), 133–146.
41. Kumwenda C., Dewey K.G., Hemsworth J., Ashorn P., Maleta K. & Haskell M.J. (2014) Lipid-based nutrient supplements do not decrease breast milk intake of Malawian infants. The American Journal of Clinical Nutrition 99 (3), 617–623.
42. Marchione T.J. (2005) Interactions with the recipient community in targeted food and nutrition programs. The Journal of Nutrition 135 (4), 886–889.
43. Markus H.R., Kitayama S. (1991) Culture and the self: Implications for cognition, emotion, and motivation. Psychological review 98 (2), 224.
44. Markus H.R. & Kitayama S. (2003) Culture, self, and the reality of the social. Psychological Inquiry 14 (3–4), 277–283.
45. Maternal and Child Nutrition Study Group (2013) Maternal and child nutrition: building momentum for impact. Lancet 382, 372–375.
46. McLeroy K.R., Bibeau D., Steckler A. & Glanz K. (1988) An ecological perspective on health promotion programs. Health Education & Behavior 15 (4), 351–377.
47. Miles M.B. & Huberman A.M. (1994) Qualitative Data Analysis, 2nd edn. Sage Publications: Thousand Oaks, CA.
48. Morgan D. (1997) Focus Groups as Qualitative Research, 2nd edn. Sage Publications: Thousand Oaks, CA.
49. Morris M.W., Lueng K., Ames D. & Lickel B. (1999) Views from inside and outside: integrating emic and etic insights about culture and justice judgment. Academy of Management Review 24 (4), 781–796.
50. Napier, A.D., Ancarno, C., Butler, B., Calabrese, J., Chater, A., Chatterjee, H. et al. (2014) Culture and health. The Lancet 384 (9954), 1607–1639.
51. Paolisso M. & Regmi C.S. (1992) Gender and the Commercialization of Subsistence Agriculture in Nepal. International Center for Research on Women and New ERA: Washington, D.C. & Kathmandu, Nepal.
52. Parker M.E., Bentley M.E., Chasela C., Adair L., Piwoz E.G., Jamieson D.J. et al. (2011) The acceptance and feasibility of replacement feeding at 6 months as an HIV prevention method in Lilongwe, Malawi: results from the BAN study. AIDS Education and Prevention 23 (3), 281–295.
53. Patton M.Q. (2002) Qualitative Evaluation and Research Methods, 3rd edn. Sage Publications: Thousand Oaks, CA.
54. Paul K.H., Muti M., Chasekwa B., Mbuya M.N., Madzima R.C., Humphrey J.H. et al. (2012) Complementary feeding messages that target cultural barriers enhance both the use of lipid-based nutrient supplements and underlying feeding practices to improve infant diets in rural Zimbabwe. Maternal and Child Nutrition 8, 225–238.
55. Phuka J., Maleta K., Thakwalakwa C., Cheung Y.B., Briend A., Manary M.J. et al. (2008) Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Archives of Pediatrics and Adolescent Medicine 162, 619–626.
56. Phuka J., Ashorn U., Ashorn P., Zeilani M., Cheung Y.B., Dewey K.G. et al. (2011) Acceptability of three novel lipid-based nutrient supplements among Malawian infants and their caregivers. Maternal and Child Nutrition 7, 368–377.
57. Prochaska J.O., Redding C.A., Harlow L.L., Rossi J.S. & Velicer W.F. (1994) The transtheoretical model of change and HIV prevention: a review. Healthy Education Quarterly 21 (4), 471–486.
58. Rah J.H., De Pee S., Kraemer K., Bloem M.W., Spiegel P., Wilkinson C. et al. (2012) Program experience with micronutrient powders and current evidence. Journal of Nutrition 142 (1), 191S–196S.
59. Sandelowski M. (2000) Combining qualitative and quantitative sampling, data collection, and analysis techniques in mixed-method studies. Research in Nursing & Health 23, 246–255.
60. Scaling up Nutrition [SUN]. A framework for action (2014). [Online] Available at: http://scalingupnutrition.org/sun-countries (Accessed 5 April 2014).
61. Scrimshaw S.C.M. & Hurtado E. (1987) Rapid Assessment Procedures for Nutrition and Primary Health Care: Anthropological Approaches to Improving Programme Effectiveness. UNU Press: Tokyo.
62. Shankar A.V., Gittelsohn J., Stalling R., West K.P., Gynwali T., Dhungel C. et al. (2001) Comparison of visual estimates of children's portion sizes under both shared-plate and individual-plate conditions. Journal of American Dietary Association 101 (1), 47–52.
63. Shankar A.V., Gittelsohn J., West K.P., Stalling R., Gnywali T. & Faruque F. (1998) Eating from a shared plate affects food consumption in vitamin A-deficient Nepali children. Journal of Nutrition 128 (7), 1127–1133.
64. Siega-Riz A.M., Estrada Del Campo Y., Kinlaw A., Reinhart G.A., Allen L.H., Shahab-Ferdows S. et al. (2014) Effect of supplementation with a lipid-based nutrient supplement on the micronutrient status of children aged 6–18 months living in the rural region of Intibucá, Honduras. Paediatric and Perinatal Epidemiology 28 (3), 245–254.
65. Speth J.D. (1990) Seasonality, resource stress, and food sharing in so-called “egalitarian” foraging societies. Journal of Anthropological Archaeology 9 (2), 148–188.
66. Strauss A. & Corbin J. (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage Publications, Inc: Newbury Park.
67. Tripp K., Perrine C.G., de Campos P., Knieriemen M., Hartz R., Ali F. et al. (2011) Formative research for the development of a market-based home fortification programme for young children in Niger. Maternal & Child Nutrition 7 (3), 82–95.
68. Vitta B. & Dewey K.G. (2012) Identifying Micronutrient Gaps in the Diets of Breastfed 6–11-Month-old Infants in Bangladesh, Ethiopia, and Viet Nam Using Linear Programming. Alive & Thrive: Washington, DC.