Information sharing
Contributions from Network members
Updates about new or on-going projects are listed here. Publications related to completed projects are listed here.
This list is in order as follows: 1) a link to Network meeting reports and abstracts; 2) studies in Africa; 3) studies in Asia; 4) studies in Latin America and the Caribbean, and 5) a global list of UNHCR programs that have included distribution of LNS as well as an array of research activities. Within each continent, studies are listed alphabetically by country.
LNS Research Network meeting 8th April 2011
Over 100 LNS Research Network members met in Washington DC to update each other. The meeting program, all abstracts, some presentations, and updates on new and planned research are all available to download from our Meetings page.
AFRICA
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. 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 and results published; there is now a follow-up study underway. 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. The LUCOMA study (treatment of moderate malnutrition) is registered at ClinicalTrials.gov as NCT01115647.
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 October 2012)
Integrated 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 0-12 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 appropriate breastfeeding practices and timely introduction of diverse complementary foods as well as distribution of Nutributter® to children 6-12 months of age in one health zone of Katanga province (approx 200,000 total population). A monitoring and evaluation system will be established. 12 months after the implementation of the program there will be a midpoint survey (including biological testing) and again 24 months after implementation. Depending on the progress of the second phase, it is anticipated that the third phase will involve scale-up of the program to additional health zones. Phase 1 (formative work) is complete and the product packaging and name have been selected. Training will start in April 2012 with program launch in May 2012. The LNS product will be introduced into the program in November 2012.
International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), U.S. Centers for Disease Control (contributed by Katie Tripp, updated March 2012)
Health and immunological responses to LNS - The Gambia
The 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). Time frame 2009-2011. This study is registered at www.controlled-trials.com as ISRCTN73571031.
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. Project duration 2009-2014. A methods paper is available for the second study – abstract and free full text. Registered at www.controlled-trials.com as ISRCTN49285450.
The Medical Research Council (MRC) The Gambia (originally contributed by Sophie Moore, updated by Mary Arimond October 2012 based on ISRCT listings and PubMed search)
WASH Benefits – Bangladesh and Kenya
Full study name: A Cluster Randomized Controlled Trial of the Benefits of Sanitation, Water Quality, Handwashing, and Nutrition Interventions on Child Health and Development. The WASH Benefits Study will provide rigorous evidence on the health and developmental benefits of water quality, sanitation, handwashing, and nutritional interventions during the first years of life. The nutritional intervention will include infant and young child feeding behavior change messaging plus the delivery of lipid-based nutrient supplements for children 6-24 months of age. The study includes two, cluster-randomized controlled trials to measure the impact of each intervention among infants in rural Bangladesh and Kenya. The studies are large in scope (~720 clusters with ~5000 newborns in Bangladesh and ~1125 clusters with 10,000 newborns in Kenya) and will measure primary outcomes 12 and 24 months after intervention delivery. Children born into the cohorts will be assessed for length-for-age, diarrhea prevalence, child development, stunting, and, in a subsample, environmental enteropathy biomarkers. The two trials began enrollment in mid to late 2012.
Project duration 2012-2015. For more information, please see the project website: www.washbenefits.net. Registered at ClinicalTrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).
UC Berkeley; Stanford University; Emory University; Innovations for Poverty Action; Kenya Medical Research Institute; ICDDR,B; Johns Hopkins University; and UC Davis (Contributed by Christine Stewart, October 2012)
Prevention of Acute Malnutrition during the Lean Season: Urban Centers in Madagascar
UNICEF, the Ministry of Health of Madagascar, and the UC CDC are partnering to evaluate the impact of blanket distribution of Plumpy’doz during the lean season on the nutritional status of children 6 to 36 months of age in Fianarantsoa I, Haute Matsiatra Region, Madagascar. In intervention areas, a one month supply of Plumpy’doz (4 pots) will be distributed twice, with no distribution in non-intervention areas. A randomly selected group of children in each area will be followed monthly (November 2009-April 2010) to assess anthropometric status, morbidity, access to food, household enrollment in other nutrition programs (food for work, cash for food etc.) and basic demographic data. Outcomes include wasting, stunting, cumulative prevalence of diarrhea and lower respiratory infection, and consumption patterns of Plumpy’Doz.
Project duration 2009-2010, with analysis on-going. For more information, download the abstract from the April 2011 LNS Research Network meeting here.
UNICEF headquarters; UNICEF Madagascar; Ministry of Health of Madagascar; US Centers for Disease Control and Prevention (CDC) (Contributed by Leisel Talley, updated October 2012)
Effect of LNS during pregnancy on adverse birth outcomes in Malawi
FANTA-3 is collaborating with the the iLiNS Project and others to investigate the extent to which adverse birth outcomes can be reduced through dietary intervention during pregnancy. While daily complementary feeding of infants with a ready-to-use, high-energy, micronutrient-fortified spread might have potential to reduce the incidence of severe stunting before the age of 18 months, it is often the case that linear growth retardation starts before 6 months of age, in the fetal period or as the result of a pre-term birth. Previous studies have shown maternal reproductive tract infections and malaria during pregnancy to be important risk factors for pre-term births and infants born with low birth weight, both of which are associated with linear growth faltering in early childhood and beyond. The randomized, controlled, clinical trial is being carried out in Malawi with 1,400 pregnant women, randomized to receive one of three daily interventions until delivery: 1) iron and folic acid supplementation, 2) multiple micronutrient supplementation, or 3) LNS. The results of the study will inform whether the multiple micronutrient supplementation or LNS during pregnancy can reduce the effect of maternal infection during pregnancy on pre-term births and infants born with low birth weight. Project duration 2011-2015. Registered at ClinicalTrials.gov as NCT01239693.
Food and Nutrition Technical Assistance Project III (FANTA-3) (contributed by Camila Chaparro, updated March 2012)
Lungwena Child Nutrition Intervention (LCNI) Studies - Malawi
The LCNI-5 trial is 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. LCNI-5 is a 4-arm efficacy trial that tests the possibility to promote healthy growth among young children. Healthy 6-mo-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. Registered at ClinicalTrials.gov as NCT00524446.
Lungwena Child Nutrition Intervention Studies (contributed by Per Ashorn, updated October 2012)
Formative research for supplementary feeding programs – Malawi and Mozambique
Researchers from Johns Hopkins Bloomberg School of Public Health are partnering with the Malawi Government, and Mozambique Ministry of Health, and the World Food Program in a formative research study to develop culturally-appropriate, supplementary feeding programs for children 6-23 months in rural Mozambique and Malawi. The aims of the study are 1) to describe patterns and determinants of intra- and inter-household food allocation in Ntchisi, Malawi and Cabo Delgado, Mozambique; 2) to identify potential barriers and facilitating factors to the appropriate use of complementary foods and food products such as Nutributter®; and 3) to describe in-home food preparation, forms of food allocation, and feeding behaviors of children 6-23 months. Findings will be used to develop culturally-appropriate message and communications strategies based on local food concepts and behavior to successfully promote complementary feeding with age-appropriate, energy-dense foods and food products such as Nutributter® that will yield appropriate and sustained usage among children 6-23 months. Study duration January to June, 2013. Download a detailed abstract here.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Malawi Government, Mozambique Ministry of Health, and World Food Program (Malawi and Mozambique), (Contributed by Stephen Kodish, January 2013)
Enhancing the Nutrition Impact of the Millennium Villages Project - Uganda
The Millennium Villages Project (MVP) implements integrated interventions in agriculture, education, health, infrastructure, gender equality, and business development, including interventions to support optimal breastfeeding and complementary feeding. MVP sites have shown improvements in household food security and diet diversity and the prevalence of stunting has declined. However, stunting levels are still high, particularly in some sites. In one high-stunting site (Ruhiira, in Uganda) MVP will undertake operational research on several approaches to preventing stunting by increasing the nutritional quality of complementary foods. The objectives of the research are to assess which approach: 1) is most acceptable among the rural population participating in the MVP; 2) results in the greatest prevention of stunting, and 3) is most suitable for scaling-up as part of the integrated development approach piloted by the MVP. This study is still in the preparation phase. Approaches under consideration include increasing dietary diversity through provision of locally available nutrient-dense foods, provision of a fortified complementary food (CSB++), and provision of LNS (Nutributter), all from 6-24 mo of age. The main donor for this project is Table for Two. Project duration 2013-2015.
Millennium Villages Project; WFP (Contributed by Roseline Remans, November 2012)
TreatFOOD study - West Africa
Médecins sans Frontières-Denmark, the Department of Human Nutrition, University of Copenhagen and the Alliance for International Medical Action (ALIMA) are collaborating to assess the effectiveness of a 3 month supplementation with new and improved food products for the treatment of moderate acute malnutrition (MAM) in infants/young children 6-23 months of age. The study is a 2-by-2-by-3 factorial trial with a total of 12 intervention groups. 1608 children will be included (approximately 134 per group). Children will be individually randomized to either: 1) newly developed iCSBS (500 kcal daily for 12 weeks); or 2) newly developed LNS (500 kcal daily for 12 weeks). In each of the iCSBS and LNS arms, children will be further randomized to a supplement based on dehulled soy or soy isolate and containing either 0%, 20% or 50% of total protein provided by dry skimmed milk (DSM). All groups will receive health and nutritional education and regular medical evaluations. The intervention will last for 12 weeks with an additional 3 months of follow-up. Primary outcome is lean mass gain from baseline to 3 months.
Project duration 2013-2014, with a pilot study in 2012. The main study will be registered at Current Controlled Trials. For more information, download the study description here.
Médecins sans Frontières-Denmark; Department of Human Nutrition, University of Copenhagen; Alliance for International Medical Action (ALIMA) (Contributed by Bernadette Chichon, October 2012)
Timing of maternal nutrition intervention – Zambia and other sites
The University of Colorado School of Medicine, supported by the Bill & Melinda Gates Foundation, the Global Network for Women’s and Children’s Health Research, and RTI International will implement an individually randomized controlled trial of the impact of the timing of a maternal nutrition intervention on infant outcomes. Study sites are in the Western Highlands of Guatemala; Northern Karnataka, India; Thatta District, Sindh Province, Pakistan; and Lusaka Province, Zambia. Women will receive either no LNS or daily LNS (modeled on the iLiNS formulation) with 118 kcal/d, commencing either ≥ 3 months preconception or at 12 weeks gestation. Women in either LNS study arm with low BMI (<19) or low weight gain (below U.S. Institute of Medicine recommendations) will in addition receive an energy and protein balanced food supplement of 300 kcal/d, without significant additional micronutrients. The primary outcome is birth length; secondary outcomes include: fetal length (longitudinal); incidence of low birth weight, infant anthropometry up to 6 mo, and infant morbidity. Duration of study: 2012 – 2017. Registration at ClinicalTrials.gov is pending.
The University of Colorado School of Medicine, Bill & Melinda Gates Foundation, Global Network for Women’s and Children’s Health Research, and RTI International (contributed by Michael Hambidge, January 2013).
SHINE Sanitation, Hygiene, Infant Nutrition Efficacy Project - Zimbabwe
The SHINE Project hypothesizes that environmental enteropathy is a major cause of child stunting and anemia, and that EE can be reduced through a package of interventions that improve household sanitation and hygiene. SHINE will measure the independent and combined effects of improved infant diets and improved sanitation/hygiene. In the infant nutrition arms of the study, SHINE will seek to improve infant diets through promoting optimal use of local foods and through use of LNS (Nutributter®) to fill remaining nutrient gaps (iron and zinc). Following a series of preliminary and formative studies and pilot testing of interventions, SHINE began enrolling participants in October of 2012. Project duration 2012-2015.
Zimbabwe Ministry of Health and Child Welfare; Zvitambo; Johns Hopkins Bloomberg School of Public Health; Cornell University; University of London; London School of Hygiene and Tropical Medicine (advisory) (Contributed by Rebecca Stoltzfus, October 2012)
ASIA
WASH Benefits – Bangladesh and Kenya
Full study name: A Cluster Randomized Controlled Trial of the Benefits of Sanitation, Water Quality, Handwashing, and Nutrition Interventions on Child Health and Development. The WASH Benefits Study will provide rigorous evidence on the health and developmental benefits of water quality, sanitation, handwashing, and nutritional interventions during the first years of life. The nutritional intervention will include infant and young child feeding behavior change messaging plus the delivery of lipid-based nutrient supplements for children 6-24 months of age. The study includes two, cluster-randomized controlled trials to measure the impact of each intervention among infants in rural Bangladesh and Kenya. The studies are large in scope (~720 clusters with ~5000 newborns in Bangladesh and ~1125 clusters with 10,000 newborns in Kenya) and will measure primary outcomes 12 and 24 months after intervention delivery. Children born into the cohorts will be assessed for length-for-age, diarrhea prevalence, child development, stunting, and, in a subsample, environmental enteropathy biomarkers. The two trials began enrollment in mid to late 2012.
Project duration 2012-2015. For more information, please see the project website: www.washbenefits.net. Registered at ClinicalTrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).
UC Berkeley; Stanford University; Emory University; Innovations for Poverty Action; Kenya Medical Research Institute; ICDDR,B; Johns Hopkins University; and UC Davis (Contributed by Christine Stewart, October 2012)
Evaluation of complementary food supplements for reducing childhood undernutrition - Bangladesh
Johns Hopkins University announces a new project, in partnership with WFP and ICDDR,B, and with in-kind support from DSM Ltd. The partners will design, develop and test three complementary food supplements (CFS), provide them to infants 6-18 months of age and evaluate impact on growth, stunting, wasting, morbidity, micronutrient status, and cognitive development. The CFS will have improved energy density, increased intrinsic as well as supplemental micronutrient bioavailability, and will contain dairy or non-dairy protein; the foods are calculated to fill the estimated gap in the nutritional requirements of children 6-18 months of age. The five-arm trial will compare three CFS to be developed with controls in which mothers will receive either nutrition education or be provided with "Plumpy'Doz" (Nutriset). Project duration 2010-2014. Registered at ClinicalTrials.gov as NCT01562379.
Johns Hopkins University, World Food Programme, and International Centre for Diarrhoeal Disease Research, Bangladesh (contributed by Parul Christian, updated February 2012)
Rang-Din Nutrition Study - Bangladesh
Full study name: Evaluation of the Nutritional Status of Pregnant and Lactating Women and Their Children Enrolled in the LAMB Project in Bangladesh. Since 2009, the USAID-funded FANTA-2 and FANTA-3 Projects have been involved in the development and implementation of research evaluating the potential of LNS and micronutrient powder (MNP) for prevention of malnutrition. In collaboration with the University of California, Davis, the International Centre for Diarrheal Disease Research, Bangladesh and World Mission Prayer League (LAMB Hospital), the effectiveness of LNS and MNP for prevention of chronic malnutrition is being explored in Bangladesh through a cluster-randomized controlled trial of approximately 4100 women and children. The study enrolls women in early pregnancy into one of three intervention arms: 1) LNS during pregnancy, lactation and for the infant from 6-24 months; 2) Iron and folic acid (IFA) tablets during pregnancy/lactation and LNS from 6-24 months; 3) IFA tablets during pregnancy/lactation and MNP from 6-24 months. These intervention arms are compared to a 4th study arm that receives the standard of care in this program setting: IFA tablets during pregnancy through 3 months postpartum. Outcomes include nutritional status of pregnant/lactating women (including micronutrient status), birth outcomes, and linear growth, motor and cognitive development and micronutrient status of infants 6-24 months of age. The cost-effectiveness of the LNS product compared to other interventions, and willingness-to-pay for LNS and MNP products in this population are also being explored. Project duration 2009-2015. Registered at ClinicalTrials.gov as NCT01715038.
Food and Nutrition Technical Assistance Project III (FANTA-3), UC Davis, ICDDR,B, and LAMB Hospital (updated by Malay Mridha and Zeina Maalouf-Manasseh, October 2012)
Timing of maternal nutrition intervention – India, Pakistan, and other sites
The University of Colorado School of Medicine, supported by the Bill & Melinda Gates Foundation, the Global Network for Women’s and Children’s Health Research, and RTI International will implement an individually randomized controlled trial of the impact of the timing of a maternal nutrition intervention on infant outcomes. Study sites are in the Western Highlands of Guatemala; Northern Karnataka, India; Thatta District, Sindh Province, Pakistan; and Lusaka Province, Zambia. Women will receive either no LNS or daily LNS (modeled on the iLiNS formulation) with 118 kcal/d, commencing either ≥ 3 months preconception or at 12 weeks gestation. Women in either LNS study arm with low BMI (<19) or low weight gain (below U.S. Institute of Medicine recommendations) will in addition receive an energy and protein balanced food supplement of 300 kcal/d, without significant additional micronutrients. The primary outcome is birth length; secondary outcomes include: fetal length (longitudinal); incidence of low birth weight, infant anthropometry up to 6 mo, and infant morbidity. Duration of study: 2012 – 2017. Registration at ClinicalTrials.gov is pending.
The University of Colorado School of Medicine, Bill & Melinda Gates Foundation, Global Network for Women’s and Children’s Health Research, and RTI International (contributed by Michael Hambidge, January 2013).
LATIN AMERICA/CARIBBEAN
Timing of maternal nutrition intervention – Guatemala and other sites
The University of Colorado School of Medicine, supported by the Bill & Melinda Gates Foundation, the Global Network for Women’s and Children’s Health Research, and RTI International will implement an individually randomized controlled trial of the impact of the timing of a maternal nutrition intervention on infant outcomes. Study sites are in the Western Highlands of Guatemala; Northern Karnataka, India; Thatta District, Sindh Province, Pakistan; and Lusaka Province, Zambia. Women will receive either no LNS or daily LNS (modeled on the iLiNS formulation) with 118 kcal/d, commencing either ≥ 3 months preconception or at 12 weeks gestation. Women in either LNS study arm with low BMI (<19) or low weight gain (below U.S. Institute of Medicine recommendations) will in addition receive an energy and protein balanced food supplement of 300 kcal/d, without significant additional micronutrients. The primary outcome is birth length; secondary outcomes include: fetal length (longitudinal); incidence of low birth weight, infant anthropometry up to 6 mo, and infant morbidity. Duration of study: 2012 – 2017. Registration at ClinicalTrials.gov is pending.
The University of Colorado School of Medicine, Bill & Melinda Gates Foundation, Global Network for Women’s and Children’s Health Research, and RTI International (contributed by Michael Hambidge, January 2013).
Comparing LNS, CSB, MNP - Guatemala
The International Food Policy Research Institute (IFPRI), in partnership with the FANTA-2 and FANTA-3 projects, is comparing the impact of LNS, corn-soy blend (CSB) or micronutrient powder (MNP) on child anthropometry in a Title II Maternal and Child Health and Nutrition program implemented by Mercy Corps in Guatemala.In addition to individual rations (LNS, CSB or MNP), the intervention package includes family food rations, which are conditional on mothers attending regular behavior change communication sessions 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. Project duration: 2010-2014. Registered at ClinicalTrials.gov as NCT01072279.
International Food Policy Research Institute , Food and Nutrition Technical Assistance Project, and Mercy Corps (contributed by Deanna Olney and Jef Leroy, updated October 2012)
Complementary food security in an urban slum, Cap Haitien, Haiti
Researchers from Washington University in St. Louis are partnering with Haiti’s Ministry of Public Health and Population (MSPP), Konbit Santé, and Meds and Food for Kids, to implement a randomized controlled trial of the effect of incorporating Nutributter® into the MSPP integrated package of well-baby services in Cap Haitien. Mother-infant pairs received: 1) integrated package (IP; standard clinic services) only; 2) IP plus Nutributter for 3 months; and 3) IP plus Nutributter for 6 months. Infants in groups 2 and 3 received Nutributter beginning at 6-8 months of age. In addition to assessing impact on infant growth and growth velocity monthly for 6 months, and again 12 months after enrollment, the study incorporated a process evaluation and qualitative methods to examine Nutributter within the IP and the transition to other complementary foods post-supplementation. Registered at ClinicalTrials.gov as NCT01552512.
George Warren Brown School of Social Work, Washington University; Ministry of Health and Population, Haiti; Konbit Santé; and Meds and Food for Kids (Contributed by Lora Iannotti, updated October 2012)
Efficacy of LNS for improving nutritional status - Intibucá, Honduras.
A 12-month randomized controlled trial among 6-18 month old infants and their mothers/caretakers to test the efficacy of an LNS product on improving nutritional and growth outcomes for non-malnourished children under 2 living in Intibucá, Honduras. A total of 18 communities were matched into cluster pairs by region and several poverty indicators. One cluster within each pair was then randomized to Intervention (n=9) or Control group (n=9). Mother-infant pairs were enrolled (n=300) in the study groups according to their cluster randomization. Both study arms received monthly nutritional education sessions and food vouchers redeemable for basic staples (granted based on household size). The intervention group received a monthly distribution of LNS (Plumpy’doz) with instructions to use it as a supplement to the child’s diet by feeding 46.3 g/day for children <12 (9tsp/day) months and 70 g/day for children >12 months (13.5 tsp/day). The primary outcomes include measures of growth and of micronutrient status (biomarkers of folate, iron, zinc, vitamin B-12, vitamin A, and riboflavin). Secondary outcomes include dietary intake and food insecurity. The study was blinded to study group allocation at the data entry level and at the biomarker analysis level. Data have been evaluated using an intent-to-treat approach with further evaluation including a sub-analysis based on adherence. Results of the primary outcomes will be disseminated upon publication. Project duration 2009-2010, with analysis on-going. Registered at ClinicalTrials.gov as NCT01312987.
University of North Carolina at Chapel Hill, Gillings School of Global Public Health; Shoulder to Shoulder Inc. ; The Mathile Institute for the Advancement of Human Nutrition; USDA, ARS Western Human Nutrition Research Center (Contributed by Yaniré Estrada, October 2012)
UNHCR Programs with LNS
In conjunction with partners in refugee camps in Algeria, Bangladesh, Djibouti, and Kenya, UNHCR has implemented routine cross-sectional nutrition surveys (one per year), supplemented in some sites by acceptability tests, operations research, and/or impact assessment. Findings are planned to be published in 2013.
Special Nutritional Product Use in Saharawi refugee camps in Algeria
Since Dec. 2010, UNHCR together with Triangle, Medicins du Monde Spain and the Algerian Red Crescent has implemented an intervention with LNS and MNP among Saharawi refugees in Algeria. Objectives: to decrease prevalence of anemia and stunting among children 6-59 months. Children 6-35 months receive blanket distribution of LNS (Nutributter (Ghazala), Nutriset) in flexible regimen with 15 sachets per month. Children 36-59 months receive blanket distribution of MNP (Chaila, Hexagon) in flexible regimen with 15 sachets per month. Pregnant and lactating women receive blanket distribution of 30 sachets of MNP (Chaila, Hexagon) Prior to intervention, an acceptability test showed high acceptability among the target groups. A baseline cross-sectional nutrition survey was conducted in October 2010. A follow-up cross-sectional nutrition survey among children 6-59 months is planned for October 2012. Main biological indicators are anemia and stunting in children 6-59 months, in conjunction with program indicators (e.g. coverage) .
Timeframe: 2009 – ongoing. Partners: UNHCR, Algerian Red Crescent, Medecins du Monde Spain, Triangle, WFP. Contact: Caroline Wilkinson, UNHCR.
Special Nutritional Product Use in Nayapara and Kutapalong refugee camps in Bangladesh
Since October 2008 various interventions with micronutrient supplementation targeting children 6-59 months, adolescent girls and pregnant and lactating women (PLW) have been implemented in Nayapara and Kutapalong refugee camps in Bangladesh. The overall objective is to decrease prevalence of anemia among all target groups. A blanket distribution of MNP to children 6-59 months and adolescent girls was initiated in October 2008 and is on-going. PLW were also originally targeted with MNP but are no longer receiving the intervention. A cohort study was conducted among children and adolescent girls after several months of implementation with MNP. In response to the sharp increase in GAM prevalence seen in 2009 nutrition survey, blanket PlumpyDoz distribution for children 6-35 months of age was initiated at the end of August 2009 for a duration of five months, replacing MNP for children aged 6-35 months while older children continued to receive MNP. Mothers were instructed to give three spoons of PlumpyDoz to each child three times a day for the five months. After the PlumpyDoz intervention MNP were re-instated for this age group. Both the impact on nutritional indicators and the feasibility and acceptability of the interventions have been studied, and papers describing the experiences of PlumpyDoz and MNP are planned to be written in 2012-2013.
Timeframe: 2008 - ongoing. Partners: UNHCR, ACF France, WFP. Contact: Caroline Wilkinson, UNHCR.
Special Nutritional Product Use in Ali Addeh refugee camp in Djibouti
An acceptability test was completed using Nutributter in children aged 6-23 months in November - December 2009. The product was found to be highly acceptable among the caregivers and the refugee community at large. From Dec. 2009 – Dec. 2010, UNHCR together with Association of Medical Doctors of Asia (AMDA) implemented blanket distribution of Nutributter for children 6-23 months. The main objective was to reduce anemia prevalence in the target population. The same intervention restarted in January 2012 with UNHCR and CARE Canada, and is planned to continue until the end of 2012. In addition to the acceptability study, there were annual cross-sectional nutrition surveys among children 6-59 months and program monitoring data.
Timeframe: 2009 - ongoing. Partners: UNHCR, AMDA (2009-2010), CARE Canada (2012), WFP. Contact: Allison Oman, UNHCR.
Special Nutritional Product Use in Dadaab refugee camps in Kenya
From November 2009 to June 2010 a blanket distribution of Nutributter was implemented for all children 12-35 months of age in Ifo, Dagahaley and Hagadera refugee camps, Dadaab, Kenya. Children from 6-11 months were not included as they were receiving fresh food vouchers during the same period. From December 2010 to September 2011 a blanket distribution of Nutributter was implemented for all children 6-23 months of age in the same camps. Cross-sectional nutrition surveys among children 6-59 months were conducted annually.
Timeframe: 2009 - 2011. Partners: UNHCR, WFP, German Society for International Cooperation (GIZ), MSF, African Development and Emergency Organisation, International Rescue Committee, Kenya Red Cross Society, ACF USA. Contact: Allison Oman, UNHCR.
Special Nutritional Product Use in Kakuma refugee camp in Kenya
From April 2011 to October 2011 a blanket distribution of Nutributter was implemented for all children 6-23 months of age in Kakuma refugee camp, Kenya. Cross-sectional nutrition surveys among children 6-59 months were conducted annually.
Timeframe: 2011. Partners: UNHCR, International Rescue Committee. Contact: Allison Oman, UNHCR.
(All UNHCR updates contributed by Ellen Andresen, UNHCR, October 2012)
