Iterative Design, Implementation and Evaluation of a Supplemental Feeding Program for Underweight Children Ages 6–59 Months in Western Uganda
Objective In this paper we describe the development, implementation, evaluation, and subsequent improvements of a supplemental feeding program that provides community-based care to underweight children in a rural East African setting, using a locally-sourced and produced ready-to-use food (RUF). Methods Production teams were trained to grind soybeans and groundnuts (peanuts), which were then mixed with moringa oleifera leaf powder to form an energy-dense supplemental food, designed for use as an RUF. Eligible children (based on low weight-for-age or mid-upper-arm circumference < 12 cm) received RUF of approximately 682 kcal per day for five weeks. Weekly growth monitoring and caregiver education were provided by trained health center staff and community volunteers. The program was evaluated by examining RUF nutrient composition, weight gain velocity, and qualitative data from key-informant interviews and home feeding observations. Results Locally-produced RUF had similar energy density but higher protein content than commercial RUTF (ready-to-use therapeutic food). Mean weight gain of children was 2.5 g/kg/day (range 0.9–6.0). Feeding observations revealed that caregivers were diluting the RUF fed to children. Production team members desired increased financial compensation for their work but were enthusiastic about the program as helpful to malnourished children. Conclusions Locally-produced RUF is a promising strategy for community-based care of moderately malnourished children. Through the production team’s entrepreneurship, a small business was formed, whereby financial incentives encouraged continued RUF production. Future efforts are needed to educate caregivers on correct RUF use and improve commercial viability in local markets.
KeywordsReady-to-use food Stunting Underweight Supplemental feeding
We wish to acknowledge the tireless work of the BBB WHM Agriculture Extension Officers, as well as health center staff members and volunteers. We gratefully acknowledge those who spearheaded Byokulia Bisemeye mu Bantu Project food production. We are grateful for technical assistance from Roey Rosenblith (VillageStartup), Jeff Rose (Full Belly Project), and Bert Rivers (Compatible Technology Incorporated). Funding for this study was through private donations to World Harvest Mission and through a UNC Entrepreneurial Public Service Fellowship from the Carolina Center for Public Service at the University of North Carolina at Chapel Hill and a grant from the GlaxoSmithKline UNC-Duke Student Global Health Research Project. We also thank Dr. Archileo Kaaya, Department of Food Science and Technology, Makerere University, Kampala, Uganda, for RUF nutrient analysis.
Stephanie B. Jilcott implemented the program, collected data, analyzed data, and drafted the manuscript. Scott B. Ickes collected data, analyzed data, and assisted in the preparation of the manuscript. Jennifer A. Myhre conceptualized the program, provided critical guidance and cultural insight upon program implementation, and revised the manuscript regarding critical intellectual content. Alice S. Ammerman helped design the qualitative evaluation and assisted in manuscript preparation and revised the manuscript regarding critical intellectual content. All authors have read and approved the version of the manuscript as submitted.
- 1.Lin, C. A., Manary, M. J., Maleta, K., Briend, A., & Ashorn, P. (2008). An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6–18 months. The Journal of Nutrition, 138(3), 593–598.PubMedGoogle Scholar
- 5.Jilcott, S. B., Masso, K. L., Ickes, S. B., Myhre, S. D., & Myhre, J. A. (2007). Surviving but not quite thriving: Anthropometric survey of children aged 6 to 59 months in a rural Western Uganda district. Journal of the American Dietetic Association, 107(11), 1983–1988. doi: 10.1016/j.jada.2007.08.002.CrossRefPubMedGoogle Scholar
- 6.Maleta, K., Kuittinen, J., Duggan, M. B., Briend, A., Manary, M., Wales, J., et al. (2004). Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food. Journal of Pediatric Gastroenterology and Nutrition, 38(2), 152–158. doi: 10.1097/00005176-200402000-00010.CrossRefPubMedGoogle Scholar
- 7.Phuka, J. C., Maleta, K., Thakwalakwa, C., Cheung, Y. B., Briend, A., Manary, M. J., et al. (2008). Complementary feeding with fortified spread and incidence of severe stunting in 6- to 18-month-old rural Malawians. Archives of Pediatrics and Adolescent Medicine, 162(7), 619–626. doi: 10.1001/archpedi.162.7.619.CrossRefPubMedGoogle Scholar
- 10.Jilcott, S. M. K., Tugume, L., Myhre, S., & Myhre, J. (2008). Animal husbandry and agriculture efforts toward program sustainability. Field Exchange: Emergency Nutrition Network, 34–36.Google Scholar
- 13.Babu, S. (2004). Rural nutrition interventions with indigenous plant foods—A case study of vitamin A deficiency in Malawi. Biotechnology, Agronomy, Society and Environment, 4(3), 169–179.Google Scholar
- 14.Price, M. D. K. (2000). The Moringa tree. ECHO technical note.Google Scholar
- 15.Linneman, Z., Matilsky, D., Ndekha, M., Manary, M. J., & Maleta, K. (2007). A large-scale operational study of home-based therapy with ready-to-use therapeutic food in childhood malnutrition in Malawi. Maternal and Child Nutrition, 3(3), 206–215. doi: 10.1111/j.1740-8709.2007.00095.x.CrossRefPubMedGoogle Scholar
- 16.Ciliberto, M. A., Sandige, H., Ndekha, M. J., Ashorn, P., Briend, A., Ciliberto, H. M., et al. (2005). Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: A controlled, clinical effectiveness trial. The American Journal of Clinical Nutrition, 81(4), 864–870.PubMedGoogle Scholar
- 18.Sandige, H., Ndekha, M. J., Briend, A., Ashorn, P., & Manary, M. J. (2004). Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food. Journal of Pediatric Gastroenterology and Nutrition, 39(2), 141–146. doi: 10.1097/00005176-200408000-00003.CrossRefPubMedGoogle Scholar