Iterative Design, Implementation and Evaluation of a Supplemental Feeding Program for Underweight Children Ages 6–59 Months in Western Uganda
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Objective In this paper we describe the development, implementation, evaluation, and subsequent improvements of a supplemental feeding program that provides community-based care to underweight children in a rural East African setting, using a locally-sourced and produced ready-to-use food (RUF). Methods Production teams were trained to grind soybeans and groundnuts (peanuts), which were then mixed with moringa oleifera leaf powder to form an energy-dense supplemental food, designed for use as an RUF. Eligible children (based on low weight-for-age or mid-upper-arm circumference < 12 cm) received RUF of approximately 682 kcal per day for five weeks. Weekly growth monitoring and caregiver education were provided by trained health center staff and community volunteers. The program was evaluated by examining RUF nutrient composition, weight gain velocity, and qualitative data from key-informant interviews and home feeding observations. Results Locally-produced RUF had similar energy density but higher protein content than commercial RUTF (ready-to-use therapeutic food). Mean weight gain of children was 2.5 g/kg/day (range 0.9–6.0). Feeding observations revealed that caregivers were diluting the RUF fed to children. Production team members desired increased financial compensation for their work but were enthusiastic about the program as helpful to malnourished children. Conclusions Locally-produced RUF is a promising strategy for community-based care of moderately malnourished children. Through the production team’s entrepreneurship, a small business was formed, whereby financial incentives encouraged continued RUF production. Future efforts are needed to educate caregivers on correct RUF use and improve commercial viability in local markets.
- Lin, C. A., Manary, M. J., Maleta, K., Briend, A., & Ashorn, P. (2008). An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6–18 months. The Journal of Nutrition, 138(3), 593–598.
- Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., & Strupp, B. (2007). Developmental potential in the first 5 years for children in developing countries. Lancet, 369(9555), 60–70. doi:10.1016/S0140-6736(07)60032-4. CrossRef
- de Onis, M., Frongillo, E. A., & Blossner, M. (2000). Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bulletin of the World Health Organization, 78(10), 1222–1233.
- de Onis, M., Blossner, M., Borghi, E., Frongillo, E. A., & Morris, R. (2004). Estimates of global prevalence of childhood underweight in 1990 and 2015. Journal of the American Medical Association, 291(21), 2600–2606. doi:10.1001/jama.291.21.2600. CrossRef
- Jilcott, S. B., Masso, K. L., Ickes, S. B., Myhre, S. D., & Myhre, J. A. (2007). Surviving but not quite thriving: Anthropometric survey of children aged 6 to 59 months in a rural Western Uganda district. Journal of the American Dietetic Association, 107(11), 1983–1988. doi:10.1016/j.jada.2007.08.002. CrossRef
- Maleta, K., Kuittinen, J., Duggan, M. B., Briend, A., Manary, M., Wales, J., et al. (2004). Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food. Journal of Pediatric Gastroenterology and Nutrition, 38(2), 152–158. doi:10.1097/00005176-200402000-00010. CrossRef
- Phuka, J. C., Maleta, K., Thakwalakwa, C., Cheung, Y. B., Briend, A., Manary, M. J., et al. (2008). Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Archives of Pediatrics and Adolescent Medicine, 162(7), 619–626. doi:10.1001/archpedi.162.7.619. CrossRef
- Enserink, M. (2008). Nutrition science. The peanut butter debate. Science, 322(5898), 36–38. doi:10.1126/science.322.5898.36. CrossRef
- Manary, M. J. (2006). Local production and provision of ready-to-use therapeutic food (RUTF) spread for the treatment of severe childhood malnutrition. Food and Nutrition Bulletin, 27(3 Suppl), S83–S89.
- Jilcott, S. M. K., Tugume, L., Myhre, S., & Myhre, J. (2008). Animal husbandry and agriculture efforts toward program sustainability. Field Exchange: Emergency Nutrition Network, 34–36.
- Gatchell, V., Forsythe, V., & Thomas, P. R. (2006). The sustainability of community-based therapeutic care (CTC) in nonemergency contexts. Food and Nutrition Bulletin, 27(3 Suppl), S90–S98.
- Collins, S., Sadler, K., Dent, N., Khara, T., Guerrero, S., Myatt, M., et al. (2006). Key issues in the success of community-based management of severe malnutrition. Food and Nutrition Bulletin, 27(3 Suppl), S49–S82.
- Babu, S. (2004). Rural nutrition interventions with indigenous plant foods—A case study of vitamin A deficiency in Malawi. Biotechnology, Agronomy, Society and Environment, 4(3), 169–179.
- Price, M. D. K. (2000). The Moringa tree. ECHO technical note.
- Linneman, Z., Matilsky, D., Ndekha, M., Manary, M. J., & Maleta, K. (2007). A large-scale operational study of home-based therapy with ready-to-use therapeutic food in childhood malnutrition in Malawi. Maternal and Child Nutrition, 3(3), 206–215. doi:10.1111/j.1740-8709.2007.00095.x. CrossRef
- Ciliberto, M. A., Sandige, H., Ndekha, M. J., Ashorn, P., Briend, A., Ciliberto, H. M., et al. (2005). Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: A controlled, clinical effectiveness trial. The American Journal of Clinical Nutrition, 81(4), 864–870.
- Patel, M. P., Sandige, H. L., Ndekha, M. J., Briend, A., Ashorn, P., & Manary, M. J. (2005). Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition. Journal of Health, Population, and Nutrition, 23(4), 351–357.
- Sandige, H., Ndekha, M. J., Briend, A., Ashorn, P., & Manary, M. J. (2004). Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food. Journal of Pediatric Gastroenterology and Nutrition, 39(2), 141–146. doi:10.1097/00005176-200408000-00003. CrossRef
- Lutter, C. K. (2003). Macrolevel approaches to improve the availability of complementary foods. Food and Nutrition Bulletin, 24(1), 83–103.
- Dewey, K. G., & Adu-Afarwuah, S. (2008). Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal and Child Nutrition, 4(Suppl 1), 24–85. doi:10.1111/j.1740-8709.2007.00124.x. CrossRef
- Dewey, K. G., & Brown, K. H. (2003). Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs. Food and Nutrition Bulletin, 24(1), 5–28.
- Santos, I., Victora, C. G., Martines, J., Goncalves, H., Gigante, D. P., Valle, N. J., et al. (2001). Nutrition counseling increases weight gain among Brazilian children. The Journal of Nutrition, 131(11), 2866–2873.
- Bhutta, Z. A., Ahmed, T., Black, R. E., Cousens, S., Dewey, K., Giugliani, E., et al. (2008). What works? Interventions for maternal and child undernutrition and survival. Lancet, 371(9610), 417–440. doi:10.1016/S0140-6736(07)61693-6. CrossRef
- Myatt, M., Khara, T., & Collins, S. (2006). A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Food and Nutrition Bulletin, 27(3 Suppl), S7–S23.
- Iterative Design, Implementation and Evaluation of a Supplemental Feeding Program for Underweight Children Ages 6–59 Months in Western Uganda
Maternal and Child Health Journal
Volume 14, Issue 2 , pp 299-306
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Ready-to-use food
- Supplemental feeding
- Industry Sectors
- Author Affiliations
- 1. Department of Public Health, Brody School of Medicine, East Carolina University, 1709 West Avenue, Greenville, NC, 27834, USA
- 2. Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- 3. World Harvest Mission, Bundinutrition Program, P.O. Box 1142, Bundibugyo, Uganda