title: Program changes are effective and cost-effective in increasing the amount of oil used in preparing corn soy blend porridge for treatment of moderate acute malnutrition in Malawi.
abstract: Corn Soy Blend (CSB) porridge is commonly prepared with oil for treatment of moderate acute malnutrition (MAM). A recent review recommended that 30 g of oil be used with 100 g of CSB to increase energy density and micronutrient absorption. This study assessed the effectiveness and cost-effectiveness of program changes aimed at achieving that target oil:CSB ratio in prepared porridge. Caregivers of children in MAM supplementary feeding programs were assigned to three groups: a control group received monthly rations of 1 L oil, 8 kg CSB in bulk, and social and behavior change communication (SBCC); intervention groups received 2.6 L oil, 8 kg CSB provided either in bulk (Group 1) or four 2-kg packages with printed messages (Group 2), and enhanced SBCC emphasizing the target oil:CSB ratio. Compared to the control, both intervention groups had higher mean added oil per 100 g CSB (18 g, p < 0.01, and 13 g, p= 0.04, higher in groups 1 and 2, respectively), and greater odds of meeting or exceeding the target ratio (28.4, p< 0.01, and 12.7, p= 0.02, in groups 1 and 2, respectively). Cost per caregiver reaching the target ratio was most favorable in Group 1 ($391 in Group 1, $527 in Group 2, and $1,666 in the control). Enhanced SBCC combined with increased oil ration resulted in increased use of oil in CSB porridge in a supplementary feeding program. Modified packaging did not improve effectiveness. However, both interventions were more cost-effective than standard programming.
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Beatrice Lorge
authors.initials: BL
authors.lastname: Rogers
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Wilner
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Gray
authors.initials: G
authors.lastname: Maganga
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Shelley Marcus
authors.initials: SM
authors.lastname: Walton
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.|Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
authors.forename: Devika J
authors.initials: DJ
authors.lastname: Suri
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Breanne K
authors.initials: BK
authors.lastname: Langlois
authors.affiliation: Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA.
authors.forename: Kenneth Kwan Ho
authors.initials: KKH
authors.lastname: Chui
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Boiteau
authors.affiliation: Department of Agricultural and Resource Economics, University of California-Davis, California, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Webb
mesh_terms: D000208:Acute Disease; D000328:Adult; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004032:Diet / Q000191:economics; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008295:Malawi / Q000453:epidemiology; D044342:Malnutrition / Q000178:diet therapy* / Q000191:economics; D018977:Micronutrients / Q000008:administration & dosage / Q000032:analysis; D010938:Plant Oils / Q000008:administration & dosage* / Q000737:chemistry; D018401:Sample Size; D012959:Socioeconomic Factors; D013025:Glycine max; D055815:Young Adult; D003313:Zea mays
chemical_list: D018977:Micronutrients; D010938:Plant Oils
keywords: Moderate acute malnutrition; corn soy blend; food aid; fortified blended food; social and behavior change communication; supplementary feeding