title: Malawian Mothers Consider Lipid-Based Nutrient Supplements Acceptable for Children throughout a 1-Year Intervention, but Deviation from User Recommendations Is Common.
abstract: BACKGROUND
  Lipid-based nutrient supplements (LNSs) offer a vehicle to improve children's diets in low-income countries where complementary foods are typically deficient in essential nutrients. Sustained acceptability by the intended users is essential for achieving growth-promoting effects.
  
  
  OBJECTIVE
  We aimed to determine the sustained acceptability of LNSs among 6- to 18-mo-old children in Malawi.
  
  
  METHODS
  In the context of a trial testing the growth-promoting effect of different formulations and doses of LNSs, we delivered LNSs to the homes of the children biweekly according to the randomization protocol. We defined acceptability to include adherence to feeding recommendations and mothers' experiences of feeding LNSs to their child. We conducted brief interviews each week with the mothers. At 2 time points we conducted knowledge, attitudes, and practices (KAP) interviews. In addition, we conducted repeated in-depth interviews with a subset of mothers.
  
  
  RESULTS
  Of the 1612 children who received the LNS intervention, we analyzed adherence data from 1478 (91.7%) children and KAP data at 2 time points (child's age of 12 and 18 mo) from 839 (52.1%) of the children. The mean ± SD overall adherence (proportion of days when the study child reportedly consumed LNSs considering only those weeks when the supplement had been successfully delivered to the home) was 92.4 ± 9.6%, and there was no difference between children receiving milk-containing or milk-free LNSs. There was also no increasing or decreasing trend over time in any of the groups. Sharing and deviation from other feeding recommendations were common. Maternal experiences were mostly very positive.
  
  
  CONCLUSIONS
  The acceptability of LNS products was good and was sustained for 12 mo in this rural Malawian population. However, sharing of the products with family members and deviation from other feeding recommendations were frequent, which means that individually targeted children were likely to receive less than the intended dose of the LNS. This trial was registered at clinicaltrials.gov as NCT00945698.
authors.affiliation: Department of International Health, School of Medicine, University of Tampere, Tampere, Finland; ulla.ashorn@uta.fi.
authors.forename: Ulla
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: Department of International Health, School of Medicine, University of Tampere, Tampere, Finland;
authors.forename: Lotta
authors.initials: L
authors.lastname: Alho
authors.affiliation: Department of Nutrition, Program in International and Community Nutrition, and.
authors.forename: Mary
authors.initials: M
authors.lastname: Arimond
authors.affiliation: Department of Nutrition, Program in International and Community Nutrition, and.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: College of Medicine, School of Public Health, University of Malawi, Blantyre, Malawi;
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.affiliation: International Lipid-Based Nutrient Supplements (iLiNS) Project, College of Medicine, University of Malawi, Mangochi, Malawi;
authors.forename: Nozgechi
authors.initials: N
authors.lastname: Phiri
authors.affiliation: College of Medicine, School of Public Health, University of Malawi, Blantyre, Malawi;
authors.forename: John
authors.initials: J
authors.lastname: Phuka
authors.affiliation: Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA;
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Nutriset S.A.S., Malaunay, France; and.
authors.forename: Mamane
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: Department of International Health, School of Medicine, University of Tampere, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
mesh_terms: D000328:Adult; D004041:Dietary Fats / Q000008:administration & dosage*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage*; D007227:Infant Nutritional Physiological Phenomena; D016015:Logistic Models; D008137:Longitudinal Studies; D008295:Malawi; D008297:Male; D009035:Mothers; D010349:Patient Compliance; D011446:Prospective Studies; D012424:Rural Population; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D004041:Dietary Fats
keywords: Malawi; children; linear growth failure; lipid-based nutrient supplement; randomized controlled trial; sustained acceptability