Designing appropriate complementary feeding recommendations: tools for programmatic action

Abstract

Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of stunting in young children from age 6 months. The design of effective programmes to improve infant and young child feeding requires a sound understanding of the local situation and a systematic process for prioritizing interventions, integrating them into existing delivery platforms and monitoring their implementation and impact. The identification of adequate food-based feeding recommendations that respect locally available foods and address gaps in nutrient availability is particularly challenging.We describe two tools that are now available to strengthen infant and young child-feeding programming at national and subnational levels. ProPAN is a set of research tools that guide users through a step-by-step process for identifying problems related to young child nutrition; defining the context in which these problems occur; formulating, testing, and selecting behaviour-change recommendations and nutritional recipes; developing the interventions to promote them; and designing a monitoring and evaluation system to measure progress towards intervention goals. Optifood is a computer-based platform based on linear programming analysis to develop nutrient-adequate feeding recommendations at lowest cost, based on locally available foods with the addition of fortified products or supplements when needed, or best recommendations when the latter are not available. The tools complement each other and a case study from Peru illustrates how they have been used. The readiness of both instruments will enable partners to invest in capacity development for their use in countries and strengthen programmes to address infant and young child feeding and prevent malnutrition.

Context-specific complementary feeding recommendations developed using Optifood could improve the diets of breast-fed infants and young children from diverse livelihood groups in northern Kenya

“…These alternative CFR were then tested, in Optifood, to select the best sets of CFR, using criteria based on predicted population-level nutrient adequacy and minimum diet cost. The process of analysing dietary data and developing CFR with Optifood has been described in detail elsewhere (14,(19)(20)(21) . In the present study, all analyses were done in Modules I to III of Optifood for each of the nine target groups.…”

Using implementation research for evidence‐based programme development: a case study from Kenya

“…The purpose of this supplement to Maternal & Child Nutrition is to contribute to this growing area of implementation research. The first, second and third papers in the supplement describe an innovative approach to landscape analysis that combined quantitative analysis using recently developed linear programming software, Optifood (Daelmans et al 2013), and application of the Focused Ethnographic Study of Infant and Young Child Feeding 6–23 Months: Behaviors, Beliefs, Contexts and Environments (FES) (Pelto & Armar‐Klemesu 2014) to identify a suite of strategies that would contribute to improving the nutrient adequacy of infant and young child (IYC) diets in Kenya. In the fourth paper, the authors step back to consider the importance of local knowledge for effective implementation, and the role of ethnography in generating it.…”

“…To inform population‐specific FBR, a mathematical approach based on Optifood has been recently developed (Daelmans et al 2013). Optifood is a powerful software tool that can help the public health nutrition community to identify FBR and evaluate the cost of meeting nutrient requirements for specific populations using locally available foods.…”

Challenges in the Elaboration of a Field Interview Instrument to Capture Information for the Evaluation of Adherence to the WHO/PAHO Guiding Principles for Complementary Feeding of the Breastfed Child

“…As illustrated in appendix 2, ProPAN lacks evaluation criteria for 3 of the 10 WHO/PAHO Guiding Principles: "practice good hygiene" (principle 4), "gradually increase food consistency and variety" (principle 6), and "use fortified complementary foods" (principle 9), but it addresses one, "practice responsive feeding" (principle 3), that our interview tool could not encompass. The ProPAN application, however, goes beyond the 10 WHO/PAHO Guiding Principles, by focusing on immediate postpartum practices, evaluating practices such as breastfeeding within 1 hour after birth, use of colostrum, and use of only breastmilk the first 3 days, as well as interesting itself in the use of nutrient-and energy-dense foods [12]. Interestingly, ProPAN uses the energy-and nutrient-density concept to evaluate the nutrient quality of the complementary foods.…”