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Contributions from Network members
CDC, UNICEF Niger and Helen Keller International Niger are working together to develop a home fortification program using either Sprinkles® or Nutributter® distributed through local mechanisms. There will be 3 phases of the project 1) formative research, 2) pilot program, 3) scale up. The goal of phase 1 is to conduct formative research in two sites in Niger to inform the design of the pilot program and the monitoring and evaluation plan. The specific objectives of phase 1 are as follows: 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 August 2009)
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, FANTA-2 will evaluate the effectiveness of LNS for prevention of chronic malnutrition in programmatic settings, potentially in Bangladesh and Guatemala. Outcomes to be assessed include linear growth, motor and cognitive development and micronutrient status of children, as well as the cost-effectiveness of the LNS product compared to other interventions. FANTA-2 will also partner with the International Food Policy Research Institute to investigate the effect of adding LNS to a food ration and behavior change communication provided in Title II Maternal and Child Health and Nutrition programs in Guatemala and Burundi, as part of a larger-scale evaluation of the “Preventing Malnutrition in Children Under-2 Approach”. 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 August 2009)
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 August 2009)
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)
The 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 effectiveness of two treatment foods for the treatment of moderate acute malnutrition in children 6-59 months of age: RUSF (Supplementary Plumpy®) and the conventional WFP treatment food, fortified blended cereal (CSB). The study will also investigate cost-effectiveness, sustainability, and feasibility for further scale-up of programs.
World Food Programme, Action Contre la Faim, and Sprinkles Global Health Initiative (contributed by Crystal Karakochuk, updated August 2009)
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)
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). 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)
Since 2008, Valid Nutrition has developed and tested the acceptability of 4 new corn-soya-sorghum recipes with little or no milk. Effectiveness trials have recently commenced or will soon commence for each of the 4 products, as follows:
- Zambia (collaboration with Lusaka District Health Management Team) - A cluster-randomized trial to compare the effectiveness and cost-effectiveness of treating severe acute malnutrition with a new milk-free corn-soy RUTF compared to standard peanut-RUTF. The main outcome will be recovery rate with weight gain as secondary outcome.
- Kenya (collaboration with Wellcome Trust/Kenya Medical Research Institute, Kilifi) - A randomized trial to compare the effectiveness, for prevention of wasting, of feeding non-wasted children presenting with acute illness with 4-week ration of a ready-to-eat supplementary food (RUSF) compared to normal diet.
- Democratic Republic of the Congo (collaboration with CEMUBAC in South Kivu) - A randomized trial to compare the effectiveness, for prevention of stunting, of feeding normal 6-12 months old infants with a 6-month ration of a ready-to-eat complementary food (RUCF) compared to standard corn-soya blend.
- Kenya (collaboration with Kenya Medical Research Institute, University College London, and MSF-France) - A randomized trial to compare the effectiveness of treating acute malnutrition among HIV-infected adults on anti-retroviral treatment with a new milk-free corn-soya RUTF compared to standard peanut-RUTF. The main outcome will be weight gain.
Valid Nutrition (contributed by Victor Owino, updated August 2009)
