Moderate Acute Malnutrition (MAM)
Conditions
Keywords
LAF, MAM, Moderate acute malnutrition, wasting, locally available foods, supplementary food, specially formulated foods, Niger, linear programming, lipid-based nutrient supplements, acceptability
Brief summary
The study consisted of two phases. Phase 1 was a recipe development phase, which aimed to identify recipes that meet ≥80% of the recommended nutrient profile for Specially Formulated Foods (SFF) used in the standard management of MAM and made with locally available ingredients. In Phase 2, the recipes developed during Phase 1 were evaluated for acceptability among children 6 to \< 24 months of age with MAM during a randomized crossover feeding study with a 30-minute observed test dose and evaluation of at-home use.
Interventions
OTHERLocally Available Food
Phase 1 of the present study developed supplementary food recipes using locally available, non-perishable ingredients. Market surveys identified 49 foods, reduced to 30 suitable items. Using linear programming in the Cost of the Diet software, 24 recipes meeting ≥80% of the nutrient profile for standard MAM treatment were generated, each including 2 g of micronutrient powder. A 2022 market survey in Maradi assessed prices and year-round availability; only six recipes met this requirement and were selected. A standardized method for at-home preparation of each recipe was developed.
Sponsors
Epicentre
Harvard School of Public Health (HSPH)
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
Participants, caregivers, and study staff were not blinded to recipe identity due to the nature of the intervention.
Intervention model description
The study had two phases. * Phase 1 (Recipe Development) focused on developing supplementary food recipes using locally available, non-perishable ingredients. Market surveys identified 49 foods, reduced to 30 suitable items. Using linear programming in the Cost of the Diet software, 24 recipes meeting ≥80% of the nutrient profile for standard MAM treatment were generated, each including 2 g of micronutrient powder. A 2022 market survey in Maradi assessed prices and year-round availability; only six recipes met this requirement and were selected. A standardized method for at-home preparation was developed. * In Phase 2 (Recipe Evaluation), six recipes developed in Phase 1 were tested in a randomized crossover study among children 6-\<24 months with MAM. The six recipes were evaluated over two days using an observed test dose at a health center, and the most acceptable recipe from the observed test dose was further evaluated during two days of at-home use.
Eligibility
Sex/Gender
ALL
Age
6 Months to 23 Months
Healthy volunteers
No
Inclusion criteria
* Moderate acute malnutrition (MAM) * Eat semi-solid or solid foods for at least 30 days * Written informed consent obtained from the child's legal guardian
Exclusion criteria
* Contraindication/allergy to any locally available ingredient of the LA-SFF recipes generated in Phase 1 Recipe Development * Live outside of the study catchment area or their caregiver planned to move outside of the study catchment area in the next month * Severe acute malnutrition (SAM) * Medical complications requiring hospital based treatment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Observed test dose acceptability | During 30 minutes of test dose administration | Consumption of ≥ 75% of the 50 g test dose within 30 minutes |
| At-home observation acceptability | 12 hours | Consumption of ≥ 75% of the caregiver-prepared recipe within the 12-hour observation period |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Observed test dose consumption | During 30 minutes of test dose administration | Consumption (defined as grams of food provided at the start of the test dose minus grams of food left at the conclusion of the test dose) |
| Observed test dose recipe organoleptic ratings | Following completion of the 30-minute test dose period | Taste, smell, odor, color, and overall as reported by the caregiver on a 5-point Likert scale (1 = "dislike a lot" and 5 = "like a lot"). |
| Observed test dose perceived child liking | Following completion of the 30-minute test dose period | Perceived child liking as reported by the caregiver on a 5-point Likert scale (1 = "dislike a lot" and 5 = "like a lot") |
| At-home observation recipe organoleptic ratings | 12 hours (7AM - 7PM on at-home observation day) | Taste, smell, odor, color, and overall as reported by the caregiver on a 5-point Likert scale (1 = "dislike a lot" and 5 = "like a lot") |
| At-home observation child willingness to eat the food | 12 hours (7AM - 7PM on at-home observation day) | Voluntarily eaten, encouraged to consume, rejected |
| At-home observation caregiver willingness to use the recipe in the future | 12 hours (7AM - 7PM on at-home observation day) | As reported on a 5-point Likert scale (1 = "not at all willing" and 5 = "extremely willing") |
Countries
Niger
Outcome results
None listed