Feeding patterns of underweight children in rural Malawi given supplementary fortified spread at home

Abstract

Fortified spread (FS), containing dry food particles embedded in edible fat, offers a convenient means for nutrition rehabilitation. To describe how caregivers feed FS to their undernourished children at home, and how FS use affects other feeding patterns, we conducted a longitudinal observational study in rural Malawi. Sixteen 6- to 17-month-old underweight children (weight-for-age z-score < -2.0; -3.0 < weight-for-height z-score < 0) received FS for 12 weeks. Twelve-hour observations were conducted before supplementation and during weeks 1, 4, 8 and 12 of FS use. FS was fed to children about two times per day; each serving was 15-20 g. The spread was first used mainly alone as a between-meal snack, and then became integrated into the typical complementary feeding pattern by being mixed with porridge. Introduction of FS reduced the number of plain porridge meals, but did not decrease the total number of meals or breastfeeds per day and did not change the daily mean time caregivers spent on feeding. Children accepted the FS well, but more FS was wasted when it was offered mixed with porridge than when given alone (23.6% vs. 1.2%, 95% CI for the difference 13.2% to 31.6%). FS supplementation is feasible for community-based nutrition interventions in Malawi because it easily becomes part of the feeding routine, does not replace other foods and does not take extra caregiver time. To limit wastage, caregivers should be advised to serve FS plain or to mix it with only a small quantity of porridge.

Intra-household use and acceptability of Ready-to-Use-Supplementary-Foods distributed in Niger between July and December 2010

“…In Niger, the perception of RUSF as a medicine or food was higher than in Malawi, where RUSF was mostly considered a food by caregivers. However, feeding patterns and behaviors related to RUSF consumption were also similar to those reported in previous studies (Flax et al, 2008(Flax et al, , 2010Galpin et al, 2007), adding further evidence that RUSF can be incorporated into the daily diets of children in different contexts without having a negative impact on other feeding habits like breastfeeding. Respondents in our study reported high levels of social pressures: the fear of negative consequences for the entire community if one caregiver does not follow the instructions was highlighted in several districts.…”

A Lipid-Based Nutrient Supplement but Not Corn-Soy Blend Modestly Increases Weight Gain among 6- to 18-Month-Old Moderately Underweight Children in Rural Malawi

“…This may have led to incomplete consumption and sharing with family members of the supplement more frequently among participants who were given CSB. Whereas the parents in our study typically reported no diversion of the supplement to unintended beneficiaries, earlier studies suggest sharing of both CSB and LNS, but this seems to occur more often with porridges (23). Additionally, due to its volume, CSB may not be a true supplement, because it likely displaces other home foods.…”

‘It was caused by the carelessness of the parents’: cultural models of child malnutrition in southern Malawi

“…, ), while other parts looked at social and cultural aspects of infant and young child feeding (Flax et al . , ). The overall goal of the ethnographic research described here was to provide information that could be used to design malnutrition prevention and treatment programmes in southern Malawi that build upon existing cultural models of care rather than simply identifying ways of changing local beliefs to fit with biomedical models.…”