Impact of Small-quantity Lipid-based Nutrient Supplements on Infant and Young Child Feeding Practices.

Objectives: Lipid-based nutrient supplements (LNS) are energy-dense and could change infant and young child feeding (IYCF) practices by changing caregiver perceptions of needs and/or child appetite and demand for breast milk and local complementary foods. We hypothesized that LNS (10-40g/day) would not have significant impacts on IYCF practices. Methods: Infants in three randomized controlled trials were assigned to receive either LNS from 9- 18 mo (Burkina Faso) or 6-18 mo (Ghana and Malawi) or a delayed intervention (DI). All caregivers were given brief didactic messages promoting continued breastfeeding and diverse diets at first distribution of LNS; messages were repeated periodically in Ghana and Malawi (all groups) and not repeated systematically in Burkina Faso. IYCF practices were assessed at 18 mo by caregiver recall of the preceding day and week. Results: The reported prevalence of continued breastfeeding did not vary by intervention group in any site, and was 97%, 74%, and 89% in Burkina Faso, Ghana, and Malawi. Reported frequency of breastfeeding yesterday also did not vary. The proportion of infants meeting the WHO recommendation for minimum dietary diversity (4+ food groups) did not differ by intervention group and was 37%, 75%, and 68% in Burkina Faso, Ghana and Malawi. In Burkina Faso, infants in the LNS group were more likely to meet the WHO recommendation for number of meals/snacks yesterday (79%, vs. 66% in DI group). Conclusions: Provision of LNS did not change most IYCF practices but increased frequency of feeding in one site.

Spot-check observational method for assessing hygiene practices: review of experience and implications for programmes.

Structured observations, considered to be the method of choice for assessing hygiene practices, are time-consuming and expensive and are subject to reactivity (households modifying their behaviours in the presence of an observer). Hygiene practices also vary from day to day. Spot-checks, an alternative approach for observation, have recently gained increased popularity. In this approach, a list of predetermined conditions is observed at one point in time during a home visit. This paper reviewed experience with spot-checks for measuring hygiene practices and discussed strengths and weaknesses of the approach and its potential usefulness to those undertaking programmes. Review of seven studies carried out in various contexts confirmed that spot-checks are a promising alternative to structured observations, because these are less intrusive, less time-consuming, more economical, and less reactive. These are, however, equally affected by day-to-day variations in practices and conditions, and repeated observations are, thus, recommended. Additional research is needed to assess the validity, reactivity, and repeatability of hygiene indicators derived from spot-checks.