Acceptability of Supplementary Foods for Children with Moderate Acute Malnutrition and Feeding Behaviours During Home-Based Treatment

TY - BOOK

T1 - Acceptability of Supplementary Foods for Children with Moderate Acute Malnutrition and Feeding Behaviours During Home-Based Treatment

AU - Iuel-Brockdorff, Ann-Sophie Julie D

N1 - CURIS 2017 NEXS 321

PY - 2017

Y1 - 2017

N2 - Moderate acute malnutrition (MAM) affects around 33 million children and is a major global healthproblem, causing increased morbidity and mortality and delayed cognitive development. Despite thedevelopment of lipid-based nutrient supplement (LNS) and enhanced versions of corn-soy blend (CSB) inrecent years, there is currently no standardized practice for the management of MAM.An optimal nutritional composition alone is however not enough for successful nutritional interventions.Acceptability of the foods provided to treat MAM is also key in the successful outcome as is feedingbehaviours, since MAM is treated within the communities. Information on these aspects is therefore crucialwhen it comes to the understanding of the effectiveness of supplementary foods for the treatment ofMAM.MethodsThe study was conducted as part of the TreatFOOD trial, a randomized controlled trial assessing theeffectiveness of new formulations of CSB and LNS. It was divided into two phases and comprised 1) a pilotstudy with 180 healthy children involving an observed test-meal and a three-day take-home ration,followed by questionnaire-based interviews to evaluate the acceptability of the different formulations ofsupplementary foods in healthy children prior to the TreatFOOD trial and to explore potential barriers tosupplementary foods that could affect acceptability. 2) Within the context of the TreatFOOD trial, a studywas carried out to evaluate the acceptability of the different formations of supplementary foods in childrenwith MAM and to explore and compare feeding behaviours related to supplementary feeding with CSB andLNS. This part of the study involved 1.546 children and their caretakers as well as a subsample ofparticipants and included a mixed method approach using questionnaires, focus group discussions, homevisits and interviews.ResultsThe pilot study showed that both CSB and LNS were equally well-accepted and there were no indicationthat the level of milk or the quality of soy had an impact on the organoleptic properties of the foods inhealthy children. Nevertheless, more children receiving CBS had leftovers compared to children receivingLNS. Similar supplementary foods used for the prevention and treatment of malnutrition were generallywell appreciated in the study context, although LNS was considered different from local foods and to ahigher extend associated with medicine.During the TreatFOOD trial, we found that although all products received good ratings, LNS was moreappreciated as was both LNS and CSB with high content of milk. In terms of organoleptic parameters suchas taste, texture and odour, the content of milk and quality of soy did not affect acceptability. As in thepilot study, CSB was not as readily consumed as LNS and was to a higher degree considered difficult tomanage. Both products were considered as a medical treatment and beneficial to child’s health.Furthermore, an encouraging feeding style was more likely to be applied when feeding with LNS, while aforced feeding style was more frequently applied when feeding CSB, which was often served unpreparedand not as frequently as recommended. Finally, a certain degree of household sharing of both CSB and LNSwas found.ConclusionThe findings suggest that both CSB and LNS were well accepted, but CSB yielded more leftovers and was toa higher degree considered difficult to manage. Also, CSB was often not served as frequently asrecommended and it was consumed unprepared. Furthermore, forced feeding was more frequently appliedwhen feeding CSB and it was more likely to be served as a meal, whereas LNS stimulated an encouragingand more tactile feeding style and was more likely to be mixed into other foods. Supplements with highcontent of milk received better ratings in terms of child and caretaker appreciation and both LNS and CSBwere considered to have medicinal qualities. Household sharing of both CSB and LNS was found.The findings presented in this thesis support the findings related to the effectiveness of the TreatFOODsupplements by determining how and for what reasons supplements developed for the treatment of MAMare accepted in the given context and how, when, where and by whom they are used. Thereby the findingscontribute to the evidence base related to the management of children with MAM.

AB - Moderate acute malnutrition (MAM) affects around 33 million children and is a major global healthproblem, causing increased morbidity and mortality and delayed cognitive development. Despite thedevelopment of lipid-based nutrient supplement (LNS) and enhanced versions of corn-soy blend (CSB) inrecent years, there is currently no standardized practice for the management of MAM.An optimal nutritional composition alone is however not enough for successful nutritional interventions.Acceptability of the foods provided to treat MAM is also key in the successful outcome as is feedingbehaviours, since MAM is treated within the communities. Information on these aspects is therefore crucialwhen it comes to the understanding of the effectiveness of supplementary foods for the treatment ofMAM.MethodsThe study was conducted as part of the TreatFOOD trial, a randomized controlled trial assessing theeffectiveness of new formulations of CSB and LNS. It was divided into two phases and comprised 1) a pilotstudy with 180 healthy children involving an observed test-meal and a three-day take-home ration,followed by questionnaire-based interviews to evaluate the acceptability of the different formulations ofsupplementary foods in healthy children prior to the TreatFOOD trial and to explore potential barriers tosupplementary foods that could affect acceptability. 2) Within the context of the TreatFOOD trial, a studywas carried out to evaluate the acceptability of the different formations of supplementary foods in childrenwith MAM and to explore and compare feeding behaviours related to supplementary feeding with CSB andLNS. This part of the study involved 1.546 children and their caretakers as well as a subsample ofparticipants and included a mixed method approach using questionnaires, focus group discussions, homevisits and interviews.ResultsThe pilot study showed that both CSB and LNS were equally well-accepted and there were no indicationthat the level of milk or the quality of soy had an impact on the organoleptic properties of the foods inhealthy children. Nevertheless, more children receiving CBS had leftovers compared to children receivingLNS. Similar supplementary foods used for the prevention and treatment of malnutrition were generallywell appreciated in the study context, although LNS was considered different from local foods and to ahigher extend associated with medicine.During the TreatFOOD trial, we found that although all products received good ratings, LNS was moreappreciated as was both LNS and CSB with high content of milk. In terms of organoleptic parameters suchas taste, texture and odour, the content of milk and quality of soy did not affect acceptability. As in thepilot study, CSB was not as readily consumed as LNS and was to a higher degree considered difficult tomanage. Both products were considered as a medical treatment and beneficial to child’s health.Furthermore, an encouraging feeding style was more likely to be applied when feeding with LNS, while aforced feeding style was more frequently applied when feeding CSB, which was often served unpreparedand not as frequently as recommended. Finally, a certain degree of household sharing of both CSB and LNSwas found.ConclusionThe findings suggest that both CSB and LNS were well accepted, but CSB yielded more leftovers and was toa higher degree considered difficult to manage. Also, CSB was often not served as frequently asrecommended and it was consumed unprepared. Furthermore, forced feeding was more frequently appliedwhen feeding CSB and it was more likely to be served as a meal, whereas LNS stimulated an encouragingand more tactile feeding style and was more likely to be mixed into other foods. Supplements with highcontent of milk received better ratings in terms of child and caretaker appreciation and both LNS and CSBwere considered to have medicinal qualities. Household sharing of both CSB and LNS was found.The findings presented in this thesis support the findings related to the effectiveness of the TreatFOODsupplements by determining how and for what reasons supplements developed for the treatment of MAMare accepted in the given context and how, when, where and by whom they are used. Thereby the findingscontribute to the evidence base related to the management of children with MAM.

UR - https://rex.kb.dk/primo-explore/fulldisplay?docid=KGL01010646448&context=L&vid=NUI&search_scope=KGL&tab=default_tab&lang=da_DK

M3 - Ph.D. thesis

SN - 978-87-7209-040-5

BT - Acceptability of Supplementary Foods for Children with Moderate Acute Malnutrition and Feeding Behaviours During Home-Based Treatment

PB - Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen

CY - Copenhagen

ER -