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- LNS Research Network
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Contributions from Network members - current research
Home fortification - NigerThe U.S. Centers for Disease Control and Prevention (CDC), UNICEF Niger and Helen Keller International Niger recently conducted formative research to inform development of a home fortification program using either Sprinkles® or Nutributter® distributed through local mechanisms. Data collection was completed in October 2009; data are currently being analyzed and a report will be forthcoming in 2010. The specific objectives were to : 1) Assess the contextual background in Niger, 2) Assess young child feeding practices especially related to the promotion of complementary food products, 3) Explore local terms, concepts and practices related to anemia, iron deficiency and iron deficiency anemia and its management among children 6-24 months of age among mothers, care givers, and health workers and 4) Assess the feasibility and sustainability of various methods for the distribution of Sprinkles® or Nutributter®. International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), U.S. Centers for Disease Control (contributed by Katie Tripp, updated July 2010) Infant and young child feeding program - Democratic Republic of the Congo
UNICEF and the DRC National Nutrition Program of the Ministry of Health (PRONANUT), with support from the U.S. CDC, intend to establish an integrated infant and young child nutrition and lipid-based nutrient supplement program. The overall goals are to decrease the prevalence of anemia and iron deficiency and improve feeding practices among children 6-12 months of age. The first phase is a formative study to assess product acceptability, inform the design of a local brand for Nutributter, and test messages for improving infant and child feeding practices. In the second phase, a pilot program will include promotion of breastfeeding and timely introduction of diverse complementary foods as well as distribution of Nutributter to children 6-12 months of age. A monitoring and evaluation system will be established and at approximately 12 months an impact assessment will be conducted. Depending on the progress of the second phase, it is anticipated that the third phase will involve scale-up of the program. Phase 1 is due to begin in August 2010 and results are anticipated by November 2010. International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), U.S. Centers for Disease Control (contributed by Katie Tripp, July 2010) Effectiveness for prevention of chronic undernutrition - Bangladesh & Guatemala
The USAID-funded FANTA-2 project is developing a portfolio of research evaluating the potential of LNS for prevention of malnutrition. In collaboration with the University of California, Davis, the effectiveness of LNS for prevention of chronic malnutrition will be explored in two programmatic settings, one in Bangladesh with the non-governmental organization Lutheran Aid to Medicine in Bangladesh (LAMB), and one in Guatemala, partnering with the Fundación de la Caficultura para el Desarrollo Rural (Funcafé). In both settings, providing LNS from 6-18 or 6-24 months of age will be compared to a control group. In addition, in Bangladesh, we will compare providing LNS during childhood, to providing LNS during pregnancy, lactation and childhood, or providing a micronutrient powder during childhood. Outcomes to be assessed include linear growth, motor and cognitive development and micronutrient status of children and mothers, as well as the cost-effectiveness of the LNS product compared to other interventions. Additional research projects will assess the use of LNS for prevention of seasonal increases in acute malnutrition, and for prevention of acute malnutrition in disaster-affected populations, as well as the combined impact of LNS and infection control on child health and nutrition. Food and Nutrition Technical Assistance II (FANTA-2) Project (contributed by Camila Chaparro, updated February 2010) Comparing LNS, CSB, MNP - Guatemala
The International Food Policy Research Institute (IFPRI), in partnership with the FANTA-2 project, will compare the impact of LNS, corn-soy blend (CSB) or micronutrient powder (MNP) on child anthropometry when incorporated in a Title II Maternal and Child Health and Nutrition program implemented by Mercy Corps in Guatemala. In addition to the individual rations (LNS, CSB or MNP ), the intervention package includes family food rations, which are conditional on mothers attending regular behavior change communication training sessions to improve infant and young child feeding and care practices, and preventive health care services for pregnant and lactating women and for infants and young children up to 2 years of age. The research is part of a large-scale evaluation of the “Preventing Malnutrition in Children Under-2 Approach” (PM2A) conducted in Guatemala and Burundi. International Food Policy Research Institute and Food and Nutrition Technical Assistance II (FANTA-2) Project (contributed by Deanna Olney and Jef Leroy, IFPRI, February 2010) Preventing growth failure - Burundi
International Medical Corps has designed a research project in Burundi to assess if a Ready to Use Complementary Food (RUCF) given for 6 months (from 6 months to 12 months of age) will reduce the incidence and prevalence of underweight and stunting. The specific objective of the study is to assess the effectiveness of a 6-month supplementation with the RUCF in preventing the occurrence of growth faltering during the first two years of life (at 12, 24 and 36 months of age). This study will be set within a multi-year intervention addressing food security and prevention of malnutrition. International Medical Corps (IMC) (contributed by K.D. Ladd, updated March 2010) Relative effectiveness of RUSF and CSB - EthiopiaThe UN World Food Programme, Action Contre la Faim – France, and the University of Toronto (Sprinkles Global Health Initiative) are implementing operational research using RUSF in WFP Supplementary Feeding Programs in Southern Ethiopia. The research will compare the relative effectiveness of two treatment foods: RUSF (Supplementary Plumpy®) and the conventional WFP treatment food, corn-soya blended flour (CSB) for the treatment of moderate acute malnutrition in children 6-60 months of age. Data will be collected over a period of six months in 4 districts (26 sites) on the children's bi-weekly anthropometric data and the supplementary feeding program performance indicators (rates of recovery, default, non-response, transfer and death). The research will also investigate caregiver-reported intra-household food sharing practices. World Food Programme, Action Contre la Faim, and Sprinkles Global Health Initiative (contributed by Crystal Karakochuk, updated February 2010) Valid Nutrition portfolio of research on acceptability and effectiveness - AfricaSince 2008, Valid Nutrition has developed and tested the acceptability of several new LNS recipes (corn-soya-sorghum, chickpea-sesame) with little or no milk. Effectiveness trials have recently commenced or will soon commence for each of the 4 products, as follows:
Valid Nutrition (contributed by Victor Owino, updated February 2010) Preventing the hunger gap – The SahelAction contre la Faim France is planning to prevent acute malnutrition before and during hunger gap in a Sahelian country in 2010 by comparing the efficacy of an intervention of cash-for-work (CFW) or food-for-work (FFW) associated or not with LNS given to children 6-36 months. Project title: LNS associated with CFW or FFW can prevent acute malnutrition in children 6-36 months. Action Contre la Faim (contributed by Cécile Salpéteur, February 2010) LNS for HIV+ women and their infants - MalawiThe University of North Carolina at Chapel Hill is conducting a study on the use of LNS for HIV-positive breastfeeding women and their infants. The study uses data from the Centers for Disease Control and Prevention-sponsored Breastfeeding, Antiretroviral, and Nutrition (BAN) Study, a clinical trial in Malawi to assess the impact of maternal nutritional supplementation and antiretroviral interventions on breastfeeding-associated HIV transmission and maternal nutritional status. This study will examine how LNS given to HIV-positive lactating women for the first six months postpartum affects their own nutritional status and health as well as the nutritional status, growth, and health of the exclusively breastfed infant. Additionally, all infants in the study were rapidly weaned from breast milk at 6-7 months and LNS was provided as a supplement (to replace breast milk) in the second six months of life. The study will analyze the effect of the supplement on the nutritional status, growth, and health of the infant from 6-12 months. If there is evidence of impact of LNS on maternal and child health and nutritional status, the policy implications are substantial for scaling up LNS through intervention programs for this vulnerable population. Carolina Population Center, University of North Carolina at Chapel Hill (contributed by Betsy Jordan-Bell, February 2010) Lungwena Child Nutrition Intervention (LCNI) Studies - Malawi
The LCNI-5, -6 and -7 trials are the most recent in a series of collaborative studies implemented by the University of Malawi College of Medicine and the University of Tampere (Finland) Medical School in rural Mangochi District. The LCNI-5 trial is a 4-arm efficacy trial that tests the possibility to promote healthy growth among young children. Healthy 6-old-infants are enrolled and randomized to receive dietary supplementation for 12 months with either nothing (but will receive a delayed intervention thereafter), micronutrient-fortified maize-soy flour (Likuni phala), LNS with milk powder, or LNS without milk but with soy protein. Main outcome measure is the incidence of severe stunting; secondary outcomes include the incidence of underweight and wasting, mean weight and length gain and head growth, morbidity, energy and nutrient intakes at 15 months of age, achievement of motor and social milestones, developmental status at 18 months of age, and the concentration of selected nutrients in body fluids at 18 months of age. A two-year post-intervention follow-up is included in the trial design. The LCNI-6 and LCNI-7 trials compare the weight gain and change in blood haemoglobin concentration among moderately underweight (but not wasted) children supplemented for 12 weeks with nothing, Likuni phala, or LNS. The difference between the two trials is that in LCNI-6, the food supplements are delivered to the participants' homes at weekly intervals whereas in the LCNI-7 the guardians are expected to collect the supplements monthly from a health centre. Thus, LCNI-6 is an efficacy trial and LCNI-7 an effectiveness trial. Lungwena Child Nutrition Intervention Studies (contributed by Per Ashorn, March 2010) Efficacy and effectiveness of LNS - Burkina Faso & Ethiopia
Researchers from the Prince Leopold Institute of Tropical Medicine and Ghent University are collaborating on a series of activities. A first set of research activities is built upon the hypothesis of the fetal origin of disease. In this context, the effect of daily maternal supplementation with a fortified lipid-based nutrient supplement (LNS) on birth outcomes and child growth during the first year of life in rural Burkina Faso was evaluated. This study follows a previous efficacy trial on multi-micronutrient supplementation during pregnancy. A second set of activities includes efficacy and effectiveness studies on the use of enhanced LNS-based complementary foods in Ethiopia and Burkina Faso. In Ethiopia the primary focus is on testing the effect of omega 3 and 6 supplements in optimized complementary feeding. The study in Burkina Faso focuses on the treatment of moderate and severe malnutrition with lipid-based supplements. Unit of Nutrition and Child Health, Public Health Department, Prince Leopold Institute of Tropical Medicine (ITM), Belgium and Research Group Food Chemistry and Human Nutrition Department of Food Safety and Food Quality Faculty of Bioscience Engineering, Ghent University, Belgium (contributed by Patrick Kolsteren, updated August 2009) Preventing increases in acute malnutrition - Kenya
Since February, 2009, ACF-USA has been conducting a blanket distribution of Plumpy'Doz for all children aged between 6 and 24 months in Mandera East Division of Mandera District, Kenya (N=5000). 46 g of Plumpy'Doz per day and per child are distributed on a monthly basis for 6 months. The main goal of the project is to prevent further deterioration of the nutritional situation in the targeted area, where the rates of global acute malnutrition have reached 30% in 2009. In parallel with this objective, the effectiveness of the product and the protocol used are studied at both district level and individual level. At district level, anthropometric and retrospective mortality surveys are conducted at baseline, mid-term and end-line. In addition, a surveillance system has been operational in the area since 2008 and will provide nutritional data for assessing the longer term impact of the distribution on the local rates of acute malnutrition. At individual level, with the same frequency as for the surveys, a sample of children is followed in order to measure the impact of the distribution on their nutritional status and physical development. This sample is compared to a control group. This study is conducted in partnership with Tufts University. Action Against Hunger (contributed by David Doledec, updated August 2009) Health and immunological responses to LNS - The GambiaThe Medical Research Council (MRC) UK’s International Nutrition Group has recently initiated two studies at their field station in Keneba, The Gambia both aimed at generating a detailed understanding of the health and immunological responses to supplementary multiple micronutrients, given in the form of LNS. The first project is a randomized trial to investigate the effects of physician-prescribed LNS on the health of children presenting to a primary health care centre in The Gambia. This study will have a specific target population, i.e. vulnerable children that self-select by presentation at the clinic, and main endpoints are return presentations at clinic and growth. A sub-study will specifically focus on children with lower-respiratory tract infections (LRTI). The second study will employ a randomized design to investigate the effects of combined pre-natal and infancy supplementation on infant immune development. This trial will seek to establish (a) which combination of supplements would be most effective and (b) the most critical periods of intervention in pregnancy and infancy. The Medical Research Council (MRC) The Gambia (contributed by Sophie Moore, updated August 2009)
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