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

Abstract

Small-quantity, lipid-based nutrient supplements (SQ-LNS) show promise to improve the quality of maternal and child diets, particularly during the first 1000 days of life. The potential of SQ-LNS to impact positively upon nutritional status relies on numerous factors, including complementary dietary intake, disease prevalence and dynamics of household utilization, including sharing practices. Therefore, this study sought to elucidate the patterns and determinants of SQ-LNS utilization among children 6-23 months and potential sharing practices of other household members prior to intervention development. In Ntchisi, Malawi and Cabo Delgado, Mozambique, both rural, agricultural settings, we conducted two home-feeding trials of 8 and 6 weeks, respectively, nested within a larger multi-phase, emergent formative research design. Multiple methods, including in-depth interviews (n = 38), direct meal observations (n = 80), full-day child observations (n = 38) and spot checks of SQ-LNS supply (n = 23), were conducted with households (n = 35 in Malawi; n = 24 in Mozambique). Overall, the SQ-LNS was utilized contrary to its recommended use, with 50% of households in Malawi reporting running out of stock too early and 87% of households in Mozambique either overusing or underusing the product. Utilization of SQ-LNS was manifested in four patterns of overuse and two of underuse and was determined by factors at multiple levels of influence. Maternal and child health efforts need to consider the reasons behind choices by households to overuse or underuse SQ-LNS and design intervention strategies to increase the likelihood of its appropriate utilization.

High Coverage and Utilization of Fortified Take-Home Rations among Children 6–35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India

“…Intra-household sharing of products targeted at young children, in particular, was a considerable challenge faced by the project. Similar finding have been observed in Malawi and Mozambique and the intra-household consumption of lipid-based nutrient supplements targeted at young children [ 19 ]. Use of "safe" drinking water or milk when preparing Bal Amrutham, though only occurring in ~15% of respondents, is likely a challenge that could be faced in other areas of India where there is little access to safe drinking water sources and water treatment products.…”

“…It is not known whether the sampling framework excluded vulnerable communities and households from the sampling frame. There is some evidence, however, to suggest that families who do not live in the catchment areas of AWCs are more likely to live in urban areas, have attained higher education levels, not be from any scheduled tribe or caste, and be wealthier [ 19 ]. The second limitation is that children over the target age range (35 months) were not surveyed and therefore results can make no inferences about households with older children.…”

Self-report vs. direct measures for assessing corn soy blend porridge preparation and feeding behavior in a moderate acute malnutrition treatment program in southern Malawi

“…This study found high rates of sharing of a product that previous literature has found to be minimal, possibly due to sharing data being self-reported in other studies. 8 The inconsistency between reported and observed sharing in our study possibly reflected a tendency to report behavior that was promoted by the intervention. However, self-report referred only to a single day, whereas observation reflected up to 5 days, which means that by direct observation, households had more opportunities to be defined as a sharing household.…”

Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger

“…In a multi-site study of LNS where comparison groups received either MMN or IFA, adherence to IFA/MMN was significantly higher than LNS in Ghana, while all three were equivalent in Malawi [ 22 ]. Sharing of LNS products among household members has been documented in the literature [ 33 ]. Barriers to supplement adherence including side effects, organoleptic properties, and pregnancy-related nausea have been reported elsewhere [ 18 , 22 ], but the fears of childbirth complications—which were highly prevalent among this population in Niger—do not appear to be discussed in other prenatal supplementation studies.…”