Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa

Ogunlade, Adebayo O; Kruger, Herculina S.; Jerling, Johann C.; Smuts, Cornelius M.; Covic, Namukolo; Hanekom, Susanna M.; Mamabolo, Ramoteme L.; Kvalsvig, Jane

doi:10.3109/09637486.2010.495710

Cited by 31 publications

(30 citation statements)

References 56 publications

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“…Loechl et al (2009) explicitly used programme theory to guide the assessment of the feasibility and acceptability of distributing MNP through a food‐assisted maternal and child health and nutrition programme in Haiti. Ogunlade et al (2011) used an implementation pathway to guide the process evaluation of MNP use in a preschool setting in South Africa, under normal field conditions and implementation constraints. Both studies relied on the use of a theoretical framework to link observed impacts and programme activities, providing useful information for programme replication or scale‐up.…”

Section: Resultsmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation.

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Section: Resultsmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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“…Both the KDI and the parent rating scale were translated into the local language by an experienced translator who had done this previously for two similar randomised controlled trials [ 38 , 39 ]. Verification of the translation was done during the training of the assessors and corrections where needed were made before final printing of the assessment tools.…”

Section: Methodsmentioning

confidence: 99%

Infant Development at the Age of 6 Months in Relation to Feeding Practices, Iron Status, and Growth in a Peri-Urban Community of South Africa

et al. 2018

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Background: Evidence on the association between feeding practices, iron deficiency, anaemia, stunting, and impaired psychomotor development during infancy is limited. This study assessed the association between psychomotor development with early feeding practices, growth, iron status, and anaemia. Methods: This was cross-sectional baseline data of a randomised controlled trial which included 6-month-old infants and their mothers or primary caregivers (n = 750) in a peri-urban community in the North West province of South Africa. The Kilifi Developmental Inventory and a parent rating scale were used to assess psychomotor development. Feeding practices and anthropometric measurements were based on the World Health Organisation (WHO) guidelines. Anaemia and iron status were determined by blood sample analysis. Results: Prevalence of anaemia and stunting for the infants were 36.4% and 28.5%, respectively. Multiple regression analysis showed that birth weight was related to combined psychomotor scores (β = −3.427 (−4.603, 1.891), p < 0.001), as well as parent rating scores (β = −0.843 (−1.507, −0.180), p = 0.013). Length-for-age z-scores were associated with combined psychomotor scores (β = −1.419 (−2.466, 0.373), p = 0.008), as well as parent rating scores (β = −0.747 (−1.483, −0.010), p = 0.047). Conclusions: In this setting, with high prevalence of anaemia and stunting, important associations between lower psychomotor development scores and birthweight as well as length-for-age z-scores in 6-month-old infants were found. These findings warrant further investigation to develop a greater understanding of factors influencing the association between child growth and psychomotor development within the first 1000 days of life.

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“…The questions in the two assessment tools were translated into the local language (Setswana) by an experienced translator who had previously done this for two similar randomized controlled trials (Ogunlade et al, 2010, Taljaard, Covic, Van Graan, & Jerling, 2013, and was fluent in the language. Validation of the translation was done during training of the assessors and corrections made where necessary, to ensure true meanings were not lost in translation.…”

Section: Psychomotor Milestone Developmentmentioning

confidence: 99%

Iodine status and associations with feeding practices and psychomotor milestone development in six‐month‐old South African infants

Osei

Baumgartner

Rothman

et al. 2016

Maternal & Child Nutrition

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Iodine is important for normal growth and psychomotor development. While infants below 6 months of age receive iodine from breast milk or fortified infant formula, the introduction of complementary foods poses a serious risk for deteriorating iodine status. This cross-sectional analysis assessed the iodine status of six-month-old South African infants and explored its associations with feeding practices and psychomotor milestone development. Iodine concentrations were measured in infant (n = 386) and maternal (n = 371) urine (urinary iodine concentration [UIC]), and in breast milk (n = 257 [breast milk iodine concentrations]). Feeding practices and psychomotor milestone development were assessed in all infants. The median (25th-75th percentile) UIC in infants was 345 (213-596) μg/L and was significantly lower in stunted (302 [195-504] μg/L) than non-stunted (366 [225-641] μg/L) infants. Only 6.7% of infants were deficient. Maternal UIC (128 [81-216] μg/L; r = 0.218, p < 0.001) and breast milk iodine concentrations (170 [110-270] μg/kg; r = 0.447, p < 0.0001) were associated with infant UIC. Most infants (72%) were breastfed and tended to have higher UIC than non-breastfed infants (p = 0.074). Almost all infants (95%) consumed semi-solid or solid foods, with commercial infant cereals (60%) and jarred infant foods (20%) being the most common solid foods first introduced. Infants who reported to consume commercial infant cereals ≥4 days weekly had significantly higher UIC (372 [225-637] μg/L) than those reported to consume commercial infant cereals seldom or never (308 [200-517] μg/L; p = 0.023). No associations between infant UIC and psychomotor developmental scores were observed. Our results suggest that iodine intake in the studied six-month-old infants was adequate. Iodine in breast milk and commercial infant cereals potentially contributed to this adequate intake.

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Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa

Cited by 31 publications

References 56 publications

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Infant Development at the Age of 6 Months in Relation to Feeding Practices, Iron Status, and Growth in a Peri-Urban Community of South Africa

Iodine status and associations with feeding practices and psychomotor milestone development in six‐month‐old South African infants

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