Food Aid Quality Review: Feasibility and Acceptability Study of Corn Soy Blend and Fortified Vegetable Oil in Malawi
Condition: Child Malnutrition
MeSH terms: Malnutrition; Child Nutrition Disorders
Study type: Interventional

Summary: 
      This research will test alternative methods of ensuring compliance with recommended
      preparation and targeting of supplementary foods for malnourished children under five years
      of age.

      The hypotheses that the proposed study intends to test are as follows:

        1. With appropriate behavior change communication (BCC) and social support, and with
           provision of CSB and FVO in the correct proportions, it is possible to get women to
           prepare CSB with oil in the recommended ratio of 100:30, and in quantities just
           sufficient for the target child.

        2. Providing CSB to Beneficiary Mothers/Caretakers pre-packaged bags of 2 kg with
           appropriate messaging and with instructions to direct the food to children and to
           prepare the CSB with oil in the recommended ratio and feed as instructed will result in
           better compliance.
    

Detailed description: 
      The first stage of the study involves working with the procurement and program staff to
      ensure that oil and CSB will be available at the same time in sufficient quantities and can
      be distributed together. We will work with program staff and outside consultants (if needed)
      to develop locally acceptable recipes for CSB plus oil. A sample of communities with MCHN
      programs will be chosen, and the intervention (consistent provision of CSB with oil, teaching
      of recipes using CSB with oil, appropriate behavioral support) implemented. Tufts and locally
      contracted researchers will interview program staff involved in procurement and supply chain
      management as well as program staff, and beneficiaries, to assess the feasibility and
      acceptability of the provision of CSB with oil, and identify barriers and problems. This
      stage is expected to take six months.

      In the second stage of the study, the CSB will be distributed in new, smaller packages in
      half the sample communities, with the other half continuing with their normal distribution.
      In preparation for this stage, during the first stage, Tufts researchers will arrange for the
      production/packaging of a sufficient supply of CSB in the new packages, and will contract
      with local communications specialists to develop appropriate messages, so these will be
      available in time for the second stage of the study. Tufts and locally contracted researchers
      will collect information from program staff on their perception of the feasibility and impact
      of the change, and will interview beneficiaries to determine how they use the CSB and whether
      their use changes with the change in packaging/messaging. We may track the effect on
      intrahousehold sharing through self report of consumption among family members. This stage
      will last about six months, with data collection from beneficiaries conducted before and up
      to six months after the start of the intervention.

      In addition to interviews and focus group discussions, we will collect samples of porridge as
      prepared in order to assess the proportion of oil, and we will conduct market observations to
      determine whether increased distribution of oil affects availability and price in the market,
      and whether market access affects beneficiary mothers' compliance with recommended
      preparation method. We will conduct a small number of in-home observations to observe
      beneficiary mothers' practices with respect to storage, preparation, and feeding of children,
      of which they might not be aware.

      The key outcomes of the study are the proportion of oil in the CSB porridge as prepared, and
      the percent of beneficiary mothers who meet the standard for the oil : CSB ratio.
    

Intervention name(s): Receive extra oil; Receives behavior changed messages on CSB package
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)