Factors that May Influence the Effectiveness of 4 Specialized Nutritious Foods in the Prevention of Stunting and Wasting in Children Aged 6-23 Months in Burkina Faso

Breanne K Langlois, Ilana R Cliffer, Laetitia Nikiema, Devika J Suri, Franck Garanet, Ye Shen, Augustin N Zeba, Shelley M Walton, Hermann B Lanou, Patrick Webb, Beatrice L Rogers, Breanne K Langlois, Ilana R Cliffer, Laetitia Nikiema, Devika J Suri, Franck Garanet, Ye Shen, Augustin N Zeba, Shelley M Walton, Hermann B Lanou, Patrick Webb, Beatrice L Rogers

Abstract

Background: A trial in Burkina Faso compared the cost-effectiveness of 4 specialized nutritious foods (SNFs) used to prevent stunting and wasting in children aged 6-23 mo.

Objectives: This article explores differences in SNF use that may have influenced effectiveness, specifically in relation to consumption by the recipient child and by any other person (i.e., sharing), other diversion from the recipient child, preparation, storage, and hygiene.

Methods: Subsamples from a geographically clustered, longitudinal trial with random assignment to Corn Soy Blend Plus with oil (CSB+ w/oil), Corn Soy Whey Blend with oil (CSWB w/oil), Super Cereal Plus (SC+), or ready-to-use supplementary food (RUSF) were selected for in-depth interviews, in-home observations, and focus group discussions.

Results: Sharing was common in all arms, with the highest reported in SC+ (73%) and highest observed in CSWB w/oil (36%). Some reported giving the ration away (highest in SC+ at 17%) or using it for other purposes (highest in CSWB w/oil at 17%). The recipient child was observed consuming the ration in 49% of households on average (38-60% by arm in CSB+ w/oil and RUSF, respectively). Qualitative reports of bitterness and spoilage emerged in the CSWB w/oil arm. Most observed households (excluding RUSF) did not prepare porridge daily as instructed (35-46% by arm). Household water samples showed either high-risk or unsafe contamination with Escherichia coli (72-78% by arm). Low percentages were observed handwashing (both child and server) before consuming the porridge.

Conclusions: The SNFs were not prepared or served as intended and diversion from the recipient was common. Storage conditions may have resulted in spoilage of the ration containing whey before reaching recipients. This article provides context about factors that may have influenced the effectiveness of these SNFs. Programming and household use of SNFs are as important as their nutrient composition. This trial was registered at clinicaltrials.gov as NCT02071563.

Keywords: Burkina Faso; children under 5; corn–soy blend; lipid-based nutrient supplements; specialized nutritious food; stunting; supplementary feeding; wasting.

Copyright © The Author(s) 2020.

Figures

FIGURE 1
FIGURE 1
Observed consumption and sharing of the ration by day of observation. *Percentage ever observed among households where the ration was present (CSB+ w/oil: n = 46 on all days; CSWB w/oil: n = 29 on days 1–3 and n = 30 on day 4; SC+: n = 28 on days 1–3 and n = 27 on day 4; RUSF: n = 32 on days 1 and 2, n = 33 on day 3, and n = 31 on day 4). CSB+ w/oil, Corn Soy Blend Plus with oil; CSWB w/oil, Corn Soy Whey Blend with oil; RUSF, ready-to-use supplementary food; SC+, Super Cereal Plus.
FIGURE 2
FIGURE 2
Reported and observed sharing of the ration. *Among the subsample of households that had an in-home observation, where the ration was present (CSB+ w/oil: n = 46 on all days; CSWB w/oil: n = 29 on days 1–3 and n = 30 on day 4; SC+: n = 28 on days 1–3 and n = 27 on day 4; RUSF: n = 32 on days 1 and 2, n = 33 on day 3, and n = 31 on day 4). **Percentage of nonmissing values (<5% missing in each arm). CSB+ w/oil, Corn Soy Blend Plus with oil; CSWB w/oil, Corn Soy Whey Blend with oil; RUSF, ready-to-use supplementary food; SC+, Super Cereal Plus.
FIGURE 3
FIGURE 3
Gaps in handwashing and measuring of ingredients observed during porridge preparations. *SC+ not delivered with oil, so oil measured is not applicable. CSB+ w/oil, Corn Soy Blend Plus with oil; CSWB w/oil, Corn Soy Whey Blend with oil; SC+, Super Cereal Plus.

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