Caregiver perceived barriers to the use of micronutrient powder for children aged 6-59 months in Bangladesh.

BACKGROUND: The effectiveness of micronutrient powder (MNP) on the health outcome of children is yet to be proved. Although studies identified the barriers to the use of MNP the underlying factors related to the barriers to the use of MNP are still unexplored. We examined the underlying factors associated with the barriers reported by the caregivers of the children aged 6-59 months in Bangladesh. METHODS: We analyzed pooled data of 3, 634 caregiver-child dyads extracted from eight cross-sectional surveys. The surveys were conducted as part of an evaluation of the Maternal, Infant and Young Children Nutrition programme (phase 2) in Bangladesh. We performed univariate analysis to find the barriers reported by the caregivers of the children. We identified the underlying factors related to the reported barriers by performing multiple logistic regression analysis. RESULTS: The mostly reported barrier was perceived lack of need for MNP among the caregivers of the children (39.9%), followed by lack of awareness of the product (21.7%) and cost of the product (18.1%). Caregivers of older children (adjusted odds ratio (aOR): 1.69; 95% CI: 1.43, 2.00) and caregivers who maintained good infant and young child feeding practices (aOR: 1.32; 95% CI: 1.12, 1.57) perceived more lack of need for MNP. Caregivers of the female children (aOR: 0.79; 95% CI: 0.63, 0.98) were less likely to report that their children disliked MNP compared to the caregivers of the male children. CONCLUSION: Programmes intended to effectively promote MNP among the caregivers of children aged 6-59 months should carefully consider the factors that could underlie the barriers to the use of MNP.

Examining the Prevalence, Nutritional Quality and Marketing of Foods with Voluntary Nutrient Additions in the Canadian Food Supply.

Foods with voluntary nutritional additions are a fast-growing sector of the global food industry. In Canada, while the addition of nutrients to foods has been regulated through fortification regulations, parallel policies which aim to encourage product innovation have also allowed for the voluntary addition of nutrients and other novel ingredients to 'supplemented' and 'functional' foods. Concerns have been raised that the consumption of these products may have negative repercussions on population health, such as high nutrient intakes inappropriate for certain population subgroups (e.g., children) and the shifting of dietary patterns to include more unhealthy foods. The aim of this study was to evaluate the prevalence, nutritional quality, and marketing characteristics of foods with added nutrients in the Canadian market. We found many nutritionally-enhanced foods contained high levels of nutrients beyond recommended intakes, despite these nutrients having no evidence of inadequacy in the Canadian population. Additionally, a large proportion of foods with added nutrients had poor nutrient profiles (were deemed 'less healthy' than their non-enhanced counterparts) and carried heavy marketing on their labels, regardless of their nutritional quality. Taken together these findings raise concerns about foods with voluntary nutrient additions and suggest the need to further investigate consumer attitudes and decision-making towards these foods.

Comparison of Micronutrient Intervention Strategies in Ghana and Benin to Cover Micronutrient Needs: Simulation of Bene-Fits and Risks in Women of Reproductive Age.

Overlapping micronutrient interventions might increase the risk of excessive micronutrient intake, with potentially adverse health effects. To evaluate how strategies currently implemented in Benin and Ghana contribute to micronutrient intake in women of reproductive age (WRA), and to assess the risk for excess intakes, scenarios of basic rural and urban diets were built, and different on-going interventions were added. We estimated micronutrient intakes for all different scenarios. Four types of intervention were included in the scenarios: fortification, biofortification, supplementation and use of locally available nutrient-rich foods. Basic diets contributed poorly to daily micronutrient intake in WRA. Fortification of oil and salt were essential to reach daily requirements for vitamin A and iodine, while fortified flour contributed less. Biofortified products could make an important contribution to the coverage of vitamin A needs, while they were not sufficient to cover the needs of WRA. Iron and folic acid supplementation was a major contributor in the intake of iron and folate, but only in pregnant and lactating women. Risk of excess were found for three micronutrients (vitamin A, folic acid and niacin) in specific contexts, with excess only coming from voluntary fortified food, supplementation and the simultaneous overlap of several interventions. Better regulation and control of fortification and targeting of supplementation could avoid excess intakes.

Assessment of the contribution of industrially processed foods to salt and iodine intake in Thailand.

Iodization of food grade salt has been mandated in Thailand since 1994. Currently, processed food consumption is increasing, triggered by higher income, urbanization, and lifestyle changes, which affects the source of salt and potentially iodized salt among the population. However, adequate information about the use of iodized salt in processed foods in Thailand is still lacking. Therefore, this study aimed to assess iodine intake through salt-containing processed foods and condiments which were identified using national survey data. Potential iodine intake from iodized salt in food products was modelled using consumption data and product salt content from food labelling and laboratory analysis. Fish sauce, soy sauce and seasoning sauces (salty condiments) have alternative regulation allowing for direct iodization of the final product, therefore modelling was conducted including and excluding these products. Daily salt intake from household salt and food industry salt (including salty condiments) was estimated to be 2.4 g for children 0-5 years of age, 4.6 g for children 6-12 years of age, and 11.5 g for adults. The use of iodized salt in processed foods (excluding salty condiments) met approximately 100% of the estimated average requirement (EAR) for iodine for non-pregnant adults and for children 6 to 12 years of age, and 50% of the EAR for iodine for children aged 0 to 5 years of age. In all cases, iodine intake from processed food consumption was greater than from estimated household iodized salt consumption. Findings suggest that iodized salt from processed foods is an important source of iodine intake, especially in adults. The use of iodized salt by the food industry should be enforced along with population monitoring to ensure sustainability of optimal iodine intake. Currently, the addition of iodine into fish sauce, soy sauce and seasoning sauces has an important role in achieving and sustaining optimal iodine intake.

Modern India and Dietary Calcium Deficiency-Half a Century Nutrition Data-Retrospect-Introspect and the Road Ahead.

Calcium and vitamin D are inseparable nutrients required for bone health. In the past half a century, the dietary calcium intake of rural, tribal, and urban India has declined. Though India is the largest producer of milk and cereals, the major source of calcium in India is through non-dairy products. The highest intake of cereals and lowest intake of milk & milk products was observed in rural and tribal subjects whereas, the intake of cereals, milk & milk products were similar in both urban and metropolitan subjects. One of the reasons for lower calcium intake was the proportion of calcium derived from dairy sources. Over the past half a century, the average 30-day consumption of cereals in the rural and urban population has declined by 30%. The Per Capita Cereal Consumption (PCCC)has declined despite sustained raise in Monthly Per capita Consumption Expenditure (MPCE) in both rural and urban households. The cereal consumption was the highest in the lowest income group, despite spending smaller portion of their income, as cereals were supplied through public distribution system (PDS). About 85% of the Indian population are vitamin D deficient despite abundant sunlight. Dietary calcium deficiency can cause secondary vitamin D deficiency. Though India as a nation is the largest producer of milk, there is profound shortage of calcium intake in the diet with all negative consequences on bone health. There is a decline in dietary calcium in the background of upward revision of RDI/RDA. There is a gap in the production-consumption-supply chain with respect to dietary calcium. To achieve a strong bone health across India, it is imperative to have population based strategies addressing different segments including supplementing dietary/supplemental calcium in ICDS, mid-day-meals scheme, public distribution system, educational strategies. Other measures like mass food fortification, biofortification, bioaddition, leveraging digital technologies, investments from corporate sector are some measures which can address this problem. India is a vast country with diverse social, cultural and dietary habits. No single measure can address this problem and requires a multi-pronged strategic approach to tackle the dietary calcium deficiency to achieve strong bone health while solving the problem of nutritional deficiency.

Food neophobia among Nigerian consumers: a study on attitudes towards novel turmeric-fortified drinks.

BACKGROUND: Knowledge on food neophobia among African consumers is scarce. Yet a good understanding in this area is essential to support the acceptance of new foods, for instance, when fortifying familiar foods to improve the health and nutritional status of the populace. In this paper, food neophobia among Nigerian consumers was assessed by their attitudes towards unfamiliar beverages, namely turmeric-fortified drinks. Turmeric was chosen as the Nigerian government is stimulating its production for income generation, but the spice is not commonly used in Nigerian foods and drinks. RESULTS: Familiar street-vended drinks, i.e. soymilk and the hibiscus-based drink zobo, were fortified with turmeric. Respondents (483) were allowed to try both the familiar and unfamiliar (turmeric-fortified) drinks. Subjects also filled in a 20-item questionnaire concerning attitudes toward food and eating. Food neophobia was measured by the Food Attitude Survey (FAS) instrument ratings. Using the FAS, people who reported liking the fortified drinks ('likers') were compared with those who disliked the drinks ('dislikers') and those who were unwilling to try the drinks ('will not tryers'). Males were found to be more food neophobic than females. Middle-class income earners, the age group of 26-35 years and respondents with the highest education levels also showed a more food neophobic attitude towards turmeric-fortified drinks. CONCLUSION: Practical insights are given regarding the introduction of novel foods to Nigerian consumers by paying attention to attitudes from respondents with different demographic characteristics. The use of influencers seems to be a promising approach to address food neophobia in Nigeria. © 2020 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Micronutrient fortification of caffeinated energy drinks and supplemented foods marketed in Canada.

To examine the micronutrient content of discretionarily fortified products marketed under Canada's current regulations, we conducted an in-store and online search for products granted Temporary Marketing Authorizations in 2018. We located 129 caffeinated energy drinks and 98 other beverage products. Most were fortified at levels well below permitted maximums, but 82.2% of energy drinks and 35.7% of other beverage products contained nutrients above 100% of Daily Values, suggesting that current fortification practices are largely gratuitous. Novelty The micronutrients in a sample of discretionarily fortified products marketed under Canada's current regulations were generally below permitted maximum levels, but many greatly exceeded nutrient requirements.

Effect of maternal prenatal food supplementation, gestational weight gain, and breast-feeding on infant growth during the first 24 months of life in rural Vietnam.

Growth faltering among children during the first five years of life is a common problem among low and middle-income countries. The purpose of this study was to determine the effect of a nutrient-rich, food-based supplement given to Vietnamese rural women prior to and/or during pregnancy on the growth of their infants during first 24 months of life and to identify maternal and newborn factors associated with the infant's growth. This prospective cohort study included 236 infants born to mothers who had received nutritional advice or a food supplement from pre-conception to term or from mid-gestation to term as part of a prior randomized controlled trial. Infant anthropometry and feeding information were monitored monthly and the infant weight for age Z-score (WAZ), length for age Z-score (LAZ), and weight for length Z-score (WLZ) were assessed at 6, 12, 18, and 24 months of age using mixed-effects regression modeling. Compared to the non-supplemented mothers, infants born to mothers receiving food supplementation from mid-gestation to term had significantly higher WLZ only at 18 months (p = 0.03) and did not differ in other outcomes. Supplementation from pre-conception to term did not affect infant growth at any time point during the first 24 months. In the entire study cohort, maternal height and gestational weight gain were positively associated with the infant's WAZ and LAZ from 6 to 24 months of age. Programs designed to improve gestational weight gain among women performing demanding physical work throughout a reproductive cycle may improve postnatal infant growth. Trial registration: Registered Clinical Trials.Gov: NCT01235767.

Iron and folic acid: natural, enriched, fortified, and supplements. Analysis of food sources in the Autonomous City of Buenos Aires. / Hierro y ácido fólico: natural, enriquecido, fortificado y suplementos. Análisis de las fuentes alimentarias en la Ciudad de Buenos Aires.

INTRODUCTION: Fortification and supplementation are two strategies for micronutrient deficiency prevention. The objective of this study was to describe the source of iron and folic acid intake throughout the life cycle in the population of the Autonomous City of Buenos Aires. POULATION AND METHODS: Analysis of the information collected in the First Survey on Nutritional Food Intake of the Autonomous City of Buenos Aires (2011), which had a probability cluster sampling design. Consumption was assessed by means of a 24-hour recall. Iron and folic acid intake was estimated and categorized into natural content, enriched wheat flour, milk from the Maternal and Child Plan, fortified foods, and supplements. RESULTS: Out of the 5369 studied individuals, practically all got iron and folic acid from natural contents (58 % and 29 % of intake, respectively). More than 90 % consumed enriched wheat flour, which provided 28 % of iron and 54 % of folic acid. Fortified food consumption and intake varied greatly. Milk intake from the Maternal and Child Plan was small, even in specific groups. Intake from supplements was low, except in children < 2 years old (30 % consumed iron supplements, which accounted for 38 % of iron). CONCLUSION: In addition to natural intake from foods, enriched wheat flour accounted for a major source of folic acid and iron in this population; intake from fortified foods and supplements varied by age group.

Introducción. La fortificación y suplementación son estrategias para la prevención de carencias de micronutrientes. El objetivo fue describir la procedencia de la ingesta del hierro y ácido fólico a lo largo del ciclo vital de la población de la Ciudad Autónoma de Buenos Aires. Población y métodos. Análisis de la información de la Primera Encuesta Alimentaria y Nutricional de la Ciudad Autónoma de Buenos Aires 2011, que tomó una muestra probabilística por conglomerados. El consumo se recabó con recordatorio de 24 horas. Se calculó el aporte de hierro y ácido fólico, y se categorizó en contenido natural, harina de trigo enriquecida, leche del Plan Materno Infantil, alimentos fortificados y suplementos. Resultados. De los 5369 individuos evaluados, prácticamente, la totalidad obtenía hierro y ácido fólico de contenido natural (el 58 % y el 29 % del consumo, respectivamente). Más del 90 % consumía harina de trigo enriquecida, que aportaba el 28 % del hierro y el 54 % del ácido fólico. Los alimentos fortificados mostraron consumo y aporte muy variable. La leche del Plan Materno Infantil mostró muy baja participación, inclusive en grupos específicos. El aporte de suplementos fue bajo, excepto en < 2 años (el 30 % consumía suplementos de hierro, que aportaban el 38 % de este). Conclusión. Además del aporte natural de los alimentos, la harina de trigo enriquecida representó una importante contribución en el consumo de ácido fólico y hierro de esta población; los alimentos fortificados y los suplementos tuvieron una participación diferente según el grupo etario.

The impact of food fortification on stunting in Zimbabwe: does gender of the household head matter?

BACKGROUND: High prevalence of stunting in children under 5 years poses a major threat to child development in developing countries. It is associated with micronutrient deficiency arising from poor diets fed to children under 5 years. Food fortification is amongst the interventions focused at reducing the incidence of stunting in children under 5 years. METHODS: Using a large-scale household data from Zimbabwe, we investigated the gender-based importance of household adoption of food fortification on the proportion of stunted children in the household. We employed propensity score matching to mitigate self-selection bias associated with household adoption of food fortification. RESULTS: We offer three major findings. Firstly, we find statistically weak evidence that female headed households are more likely to adopt food fortification than their male counterparts. Secondly, food fortification reduces the proportion of stunted children in the household. Finally, in comparison to non-adopters, female headed households that adopt food fortification are more able to reduce the proportion of stunted children in their households than their male counterparts. CONCLUSION: The results highlight the need for policy makers to actively promote food fortification, as such interventions are likely to contribute to the reduction of stunting and to involve men in fortification interventions to improve on their knowledge and appreciation of fortified foods and the associated benefits.

Zinc Supplementation and Fortification in Mexican Children.

BACKGROUND: Zinc is an essential micronutrient for human health. Approximately 1.4% of deaths worldwide are related to zinc deficiency. In Mexico, 33% of children younger than 5 years are zinc deficient. OBJECTIVE: To give an overview of zinc supplementation and fortification in children younger than 5 years through the analysis of current regulations in Mexico, the availability of these products, and the opinion of Mexican experts in this field. METHODS: We gave an overview of zinc supplementation and fortification strategies in the Mexican pediatric population by conducting a literature review of Mexican studies and national standards concerning zinc supplementation and fortification. Semistructured interviews were conducted with personnel from the main producers of zinc supplements and fortified products and from social assistance programs in Mexico. RESULTS: Zinc supplementation in Mexico has been associated with reduction in the duration and incidence of diarrhea. Through interviews with experts, we identified several barriers in achieving adequate zinc consumption such as problems in social assistance programs that distribute zinc-fortified foods, lack of specific dietary recommendations regarding the intake of zinc, lack of regulation of nonpatented zinc supplements, and inconsistencies in public health actions due to political and administrative changes. CONCLUSION: Despite current regulation and efforts made by social assistance programs, zinc deficiency continues to be a prevalent public health issue. Mexico requires an in-depth analysis of existing barriers and alternatives in order to reduce zinc deficiency.

Iodine-fortified toddler milk improves dietary iodine intakes and iodine status in toddlers: a randomised controlled trial.

PURPOSE: We aimed to evaluate the effectiveness of consuming iodine-fortified toddler milk for improving dietary iodine intakes and biochemical iodine status in toddlers. METHODS: In a 20-week parallel randomised controlled trial, healthy 12-20-month-old children were assigned to: Fortified Milk [n = 45; iodine-fortified (21.1 µg iodine/100 g prepared drink) cow's milk], or Non-Fortified Milk (n = 90; non-fortified cow's milk). Food and nutrient intakes were assessed with 3-day weighed food records at baseline, and weeks 4 and 20. Urinary iodine concentration (UIC) was measured at baseline and 20 weeks. RESULTS: At baseline, toddlers' median milk intake was 429 g/day. There was no evidence that milk intakes changed within or between the groups during the intervention. Toddlers' baseline geometric mean iodine intake was 46.9 µg/day, and the median UIC of 43 µg/L in the Fortified Milk group and 55 µg/L in the Non-Fortified Milk group indicated moderate and mild iodine deficiency, respectively, with this difference due to chance. During the intervention, iodine intakes increased by 136% (p < 0.001) and UIC increased by 85 µg/L (p < 0.001) in the Fortified Milk group compared to the Non-Fortified Milk group. The 20-week median UIC was 91 µg/L in the Fortified Milk group and 49 µg/L in the Non-Fortified Milk group. CONCLUSIONS: Consumption of ≈ 1.7 cups of iodine-fortified toddler milk per day for 20 weeks can increase dietary iodine intakes and UIC in healthy iodine-deficient toddlers. This strategy alone is unlikely to provide sufficient intake to ensure adequate iodine status in toddlers at risk of mild-to-moderate iodine deficiency.

Vitamin D-fortified foods improve wintertime vitamin D status in women of Danish and Pakistani origin living in Denmark: a randomized controlled trial.

PURPOSE: Low vitamin D status is prevalent worldwide. We aim to investigate the effect of vitamin D fortification on serum 25-hydroxyvitamin D (25(OH)D) concentration in women of Danish and Pakistani origin at risk of vitamin D deficiency. METHODS: A 12-week randomized, double-blinded, placebo-controlled intervention trial during winter time, designed to provide 20 µg vitamin D3/day through fortified yoghurt, cheese, eggs and crisp bread, and assess the change in serum 25(OH)D. Participants were 143 women of Danish and Pakistani origin, living in Denmark, randomized into four groups, stratified by ethnicity. RESULTS: Mean (SD) baseline 25(OH)D concentrations among women of Danish and Pakistani origin were 49.6 (18) and 46.9 (22) nmol/L, respectively (P = 0.4). While 9% of Danish women had 25(OH)D < 30 nmol/L, the prevalence among women of Pakistani origin was 24%. Median (IQR) vitamin D intake among Danish and Pakistani women at endpoint was 32.0 (27.0, 34.4) µg/day and 24.2 (19.2, 30.8) µg/day, respectively. Endpoint serum 25(OH)D increased in fortified groups to 77.8 (14) nmol/L among Danish women and 54.7 (18) nmol/L among women of Pakistani origin (P < 0.01). At endpoint, 0% in the Danish-fortified group and 3% in the Pakistani-fortified group had 25(OH)D < 30 nmol/L, compared with 23 % and 34% in their respective control groups. CONCLUSIONS: Vitamin D fortification of four different foods for 12 weeks during winter was effective in increasing serum 25(OH)D and reducing the prevalence of very low vitamin D status among women of Danish and Pakistani origin. CLINICALTRIALS. GOV WITH IDENTIFIER: NCT02631629.

Mixed methods evaluation explains bypassing of vouchers in micronutrient powder trial in Mozambique.

Micronutrient powders (MNP) are recommended by the World Health Organization as an effective intervention to address anaemia in children. A formative process evaluation was conducted to assess the viability of a model using free vouchers in two districts of Mozambique to deliver MNP and motivate adherence to recommendations regarding its use. The evaluation consisted of (a) an examination of programme outcomes using a cross-sectional survey among caregivers of children 6-23 months (n = 1,028) and (b) an ethnographic study to investigate delivery experiences and MNP use from caregiver perspectives (n = 59), programme managers (n = 17), and programme implementers (n = 168). Using a mixed methods approach allowed exploration of unexpected programme outcomes and triangulation of findings. The survey revealed that receiving a voucher was the main implementation bottleneck. Although few caregivers received vouchers (11.5%, CI [9.7, 13.6]), one-fourth received MNP by bypassing the voucher system (26.3%, CI [23.6, 29.0]). Caregivers' narratives indicated that caregivers were motivated to redeem vouchers but encountered obstacles, including not knowing where or how to redeem them or finding MNP were not available at the shop. Observing these challenges, many programme implementers redeemed vouchers and distributed MNP to caregivers. Virtually, all caregivers who received MNP reported ever feeding it to their child. This study's findings are consistent with other studies across a range of contexts suggesting that although programmes are generally effective in motivating initial use, more attention is required to improve access to MNP and support continued use.

Predictors of micronutrient powder (MNP) knowledge, coverage, and consumption during the scale-up of an integrated infant and young child feeding (IYCF-MNP) programme in Nepal.

Large-scale programmes using micronutrient powders (MNPs) may not achieve maximum impact due to limited/inappropriate MNP coverage, consumption, and use. We identify predictors of MNP coverage, maternal knowledge of appropriate use, and child MNP consumption in Nepal. A cross-sectional survey was conducted in 2,578 mother-child pairs representative of children 6-23 months in two districts that were part of the post-pilot, scale-up of an integrated infant and young child feeding-MNP (IYCF-MNP) programme. Children aged 6-23 months were expected to receive 60 MNP sachets every 6 months from a female community health volunteer (FCHV) or health centre. Outcomes of interest were MNP coverage (ever received), maternal knowledge of appropriate use (correct response to seven questions), repeat coverage (receipt ≥ twice; among children 12-23 months who had received MNP at least once, n = 1342), and high intake (child consumed ≥75% of last distribution, excluding those with recent receipt/insufficient time to use 75% at recommended one-sachet-per-day dose, n = 1422). Multivariable log-binomial regression models were used to identify predictors of the four outcomes. Coverage, knowledge of appropriate use, and repeat coverage were 61.3%, 33.5%, and 45.9%, respectively. Among MNP receivers, 97.9% consumed MNP at least once and 38.9% of eligible children consumed ≥75% of last distribution. FCHV IYCF-MNP counselling was positively associated with knowledge, coverage, repeat coverage, and high intake; health worker counselling with knowledge and coverage indicators; and radio messages with coverage indicators only. FCHV counselling had the strongest association with knowledge, coverage, and high intake. Community-based counselling may play a vital role in improving coverage and intake in MNP programmes.

Predictors of micronutrient powder sachet coverage and recent intake among children 12-23 months in Eastern Uganda.

We evaluated predictors of micronutrient powder (MNP) sachet coverage and recent intake using data from a cross-sectional survey representative of children aged 12-23 months in Amuria district, Uganda. In June/July 2016, caregivers were interviewed 12 months after implementation of an integrated MNP and infant and young child feeding pilot (N = 761). Logistic regression described predictors of (a) high-MNP sachet coverage (received at least 60 sachets/6 months) and (b) recent intake (consumed MNP during the 2 weeks preceding the survey) among children who had ever received MNP and had complete data (N = 683). Fifty-nine percent (95% Confidence Interval [CI] [53.8, 64.2]) of children had high-MNP sachet coverage, and 65.4% (95% CI [61.0, 69.9]) had recent intake. MNP ration cards (Adjusted Odds Ratio [AOR] 2.67, 95% CI [1.15, 6.23]), organoleptic changes to foods cooked with soda ash (AOR 1.52, 95% CI [1.08, 2.14]), having heard of anaemia (AOR 1.59, 95% CI [1.11, 2.26]), knowledge of correct MNP preparation (AOR 1.89, 95% CI [1.11, 3.19]), and current breastfeeding (AOR 2.04, 95% CI [1.36, 3.08]) were positively associated with MNP coverage whereas older child age (18-23 vs. 12-17 months) was inversely associated with coverage (AOR 0.32, 95% CI [0.23, 0.50]). MNP ration cards (AOR 2.86, 95% CI [1.34, 6.09]), having heard an MNP radio jingle (AOR 1.40, 95% CI [1.01, 1.94]), knowledge of correct MNP preparation (AOR 1.88, 95% CI [1.04, 3.39]), and the child not disliking MNP (AOR 1.90, 95% CI [1.13, 3.22]) were positively associated with recent intake. Interventions that increase caregiver knowledge and skills and focus on older children could improve MNP coverage and recent intake.

Ethiopian mothers' experiences with micronutrient powders: Perspectives from continuing and noncontinuing users.

As part of a formative evaluation of a micronutrient powder (MNP) trial in Ethiopia that was organized according to a programme impact pathway model, we conducted in-depth focused ethnographic interviews with caregivers of children between 6 and 23 months who had accepted to try "Desta," a locally branded MNP. After stratification into two subgroups by child age, respondents were randomly selected from lists of caregivers who had received MNP from government health workers between 1 and 3 months prior to the interview date. Thirty women who were either currently giving Desta to their child ("continuing users," n = 14) or had stopped feeding Desta ("noncontinuing users," n = 16) were purposefully recruited from both urban and rural areas in the two different regions where the trial was conducted. Interviews were recorded, transcribed and translated, and coded for both emerging and prespecified themes. On the basis of identifiable components in the caregiver adherence process, this paper focuses exclusively on factors that facilitated and inhibited "appropriate use" and "continued use." For "appropriate use," defined as the caregiver preparing and child consuming MNP as directed, we identified four common themes in caregiver narratives. With respect to "continued use," the caregiver providing and child consuming the minimum number of MNP sachets over a recommended time period, our interviews spontaneously elicited five themes. We also examined caregivers' perceptions related to problems in obtaining refills. Attention to caregivers' perspectives reflected in their narratives offers opportunities to improve MNP utilization in Ethiopia, with potential application in other social and cultural settings.

We still don't know that our children need vitamin D daily: a study of parents' understanding of vitamin D requirements in children aged 0-2 years.

BACKGROUND: Vitamin D deficiency has been highlighted as a serious public health problem in the United Kingdom. One in four toddlers are not achieving the recommended intake for their healthy development. This study uses quantitative and qualitative methods to explore parents' perceptions, awareness and behaviours around vitamin D intake, and the acceptability of and factors affecting purchasing of food and drink fortified with Vitamin D in children aged 0-2 years old. METHODS: One hundred and ninety-four parents completed an online questionnaire, advertised to parents with one child aged up to 2 years on popular social media websites. The majority of participants were mothers, White-British ethnic background, aged 25-44 years. Participants provided an email address if they wanted to be contacted about the focus groups. Recruitment posters advertising the focus groups were placed in community centres. Eighteen participated in 5 focus groups (13 parents), and 5 individual interviews. A thematic analysis methodology was applied. RESULTS: Fifty-seven percent (n = 110) of parents reported receiving information about vitamin D during pregnancy and 52% (n = 100) after the birth of their child. Parents reported a low level of satisfaction with vitamin D information: many thought it was limited and recommendations on supplements were unclear. Parents wanted more information about vitamin D requirements for their child (80%, n = 153 out of 192 respondents, 2 non-response), about vitamin D and breastfeeding (56%, n = 108) and vitamin D and pregnancy (49%, n = 94). The recommendations were for simpler, easier to read, with specific and clearer guidelines; delivered regularly during routine appointments, at timely stages throughout pregnancy and after the birth. 23% (n = 45, out of 194 respondents) of parents did not know why vitamin D is important for health. Only 26% (n = 49, out of 192 respondents) of parents reported giving their youngest child a vitamin D supplement on most days of the week. The majority of parents (interview/focus group) wanted more information about foods/drinks fortified with vitamin D. CONCLUSION: Parents were generally not aware of the importance of vitamin D, dietary requirements including supplementation and the availability of vitamin D fortified foods. Major improvements are required for the effective promotion of vitamin D information to parents.

Impact of behaviour change communication interventions on sales of fortified sunflower oil in Tanzania: A spatial-temporal analysis and association study.

The Masava project was implemented in Manyara and Shinyanga regions in Tanzania to improve vitamin A intake by making available vitamin A-fortified sunflower oil with a subsidy through a mobile phone-based e-Voucher system. This study was conducted to assess the impact of the behaviour change communication (BCC) campaign of the project on volume of sales of vitamin A-fortified sunflower oil. The e-Voucher system provides real-time data on the number of e-Vouchers redeemed. The number, type, and locations of BCC events were obtained from the implementation agency. Multivariate linear regression was used to examine the associations between (a) the number and type of BCC events conducted in a ward and the volume of subsequent fortified oil redeemed in the ward and (b) distance of clinic shows, a component of the BCC campaign, from participating retailers and the volume of fortified oil redeemed in the store. After 1 year of the campaign, the volume of fortified oil redeemed monthly increased by more than 5 times in Manyara and by more than three times in Shinyanga. Among the different types of BCC events conducted, only clinic shows and cooking shows were significantly associated with the volume of redemptions (p < .05). Compared with retailers where at least one clinic show was conducted within 0.5 km from its location, the volume of redemptions was significantly lower at retailers where no clinic show conducted within 3.0 km from its location (p < .05). These findings suggest that future health promotion interventions in rural Africa should involve health clinics.

A Randomized Crossover Study to Evaluate Recipe Acceptability in Breastfeeding Mothers and Young Children in India Targeted for a Multiple Biofortified Food Crop Intervention.

BACKGROUND: A multiple biofortified food crop trial targeting iron, zinc, and vitamin A deficiencies among young children and their breastfeeding mothers is planned in India. OBJECTIVE: To determine the acceptability of recipes prepared with control and biofortified pearl millet, wheat, lentils, and sweet potato. METHODS: Children (6-24 months) and their mothers were enrolled as pairs (n = 52). Weight and height/length were determined. Mothers and children were separately, individually randomized in a crossover design to control or biofortified recipes. Children's 3-day intake was measured per recipe and crop variety. For mothers, a 9-point hedonic scale evaluated color, odor, taste, and overall acceptability. RESULTS: Children's mean (SD) length-/height-for-age Z-score was -1.2 (1.7), with 27% < -2 (stunted). Mean weight-for-length Z-score was -0.6 (1.2) with 9.6% < -2 (wasted). Mother's body mass index showed 17% <18.5 and 38% >25. There was no difference in the children's intake of biofortified versus control varieties of any recipe (P ≥ .22); overall median daily intake was 75 g (Q1: 61, Q3: 100). Mother's hedonic scores for color, odor, taste, or overall acceptability did not demonstrate any notable differences (P ≥ .23 for overall acceptability); combined median overall acceptability score was 8.5 (Q1: 8.0, Q3: 9.0). CONCLUSIONS: Recipes were consumed readily, were rated as highly acceptable, and did not show any differences between biofortified and control varieties.