Peanut-based ready-to-use therapeutic food: acceptability among malnourished children and community workers in Bangladesh

Abstract

with a community-based nutrition programme that has been using PPN for the management of acute malnutrition among children in a slum setting in Dhaka, Bangladesh. Bangladesh has one of the highest prevalence rates of childhood malnutrition in the world: 6,7 almost 46% of children aged <5 years are stunted (low height for age) and 15% are wasted (low weight for height). 8 During the implementation of this nutrition programme, several care givers of children complained of diffi culties in feeding their children with PPN and attributed it to the taste and smell of PPN. The programme also faced challenges in terms of a high lossto-follow-up rate (15-17%) and relatively low nutritional recovery rates (59-65%) compared to those reported in the literature. 9 A relatively long average length of stay in the programme (60-63 days) has also been observed. We are concerned that these fi ndings might be related to the overall acceptability of PPN, which is a key determinant in ensuring favourable outcomes of nutritional rehabilitation. While some studies in Africa have shown that peanut-based RUTF has good acceptability and compliance among severely malnourished children, 10-12 other studies have demonstrated barriers to its use and inadequate compliance, mainly due to sharing within the households. 13,14 There is, however, limited published literature on PPN acceptability in South Asia.In the present study, we assessed the acceptability of PPN among 1) care givers of malnourished children and 2) community health workers (CHWs), in Kamrangirchar slum, Dhaka, Bangladesh. METHODS DesignThis was a cross-sectional semi-structured questionnaire survey. Study setting and study populationThe study was conducted between April and June 2011 in Kamrangirchar, an urban slum setting in Dhaka, Bangladesh, with about 400 000 inhabitants living in an area of 3.1 km 2 . It is not offi cially considered as part of Dhaka City, and all health services are outsourced to non-governmental organisations, who are the main providers.MSF started its nutrition programme for children in May 2010. All services are provided free of charge . It is to be noted that 47% of children needed encouragement or were forced to eat PPN, while 5% completely rejected it after 3 weeks. Of the 29 CHWs interviewed, 48% were dissatisfied with PPN's taste and consistency, and 55% with its smell. However, 91% of the care givers and all CHWs still perceived a therapeutic benefit of PPN for malnourished children. Conclusion: Despite a therapeutic benefit, only 4 in 10 care givers perceived PPN as being acceptable as a food product, which is of concern. Interna onal Union Against Tuberculosis and Lung Disease

Acceptability of locally produced ready‐to‐use therapeutic foods in Ethiopia, Ghana, Pakistan and India

“…Multiple acceptability trials in South Asia have shown limited acceptability of RUTF and demonstrate a need for more culturally accepted ingredients and formulations (Ali et al . ; Nga et al . ).…”

Impact of lipid‐based nutrient supplements and corn–soy blend on energy and nutrient intake among moderately underweight 8–18‐month‐old children participating in a clinical trial

“…While a recent study has shown that LNS has poor acceptability of LNS among malnourished children in South Asia (Ali et al . ), some studies in Africa have shown that LNS has an excellent acceptability by the children (Flax et al . ; Hess et al .…”

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

“…Two caregivers in Ethiopia specifically mentioned their child disliked the texture of RUTF and two mentioned that the taste was unacceptable; however, these limited data do not indicate a clear trend. Some evidence suggests that RUTF palatability varies according to traditional dietary differences and this remains a subject of debate (34)(35)(36) . However, given that most caregivers in this setting were able to overcome the barrier of RUTF refusal, particularly after receiving counselling, this issue potentially could be remedied in this setting by reinforced training in administering appetite tests, negotiation skills and improved counselling on proper feeding of RUTF.…”