Willingness-to-Pay for LNS Products: Evidence from the iLiNS Studies.

Objectives: Households’ stated willingness-to-pay (WTP) for small-quantity lipid-based nutrient supplements (LNS) influence the economic viability of retail outlets for these products, and will guide public policy action when WTP falls short of LNS production/distribution costs. This presentation provides evidence on WTP for LNS products tested in the context of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Malawi, Ghana and Burkina Faso. Methods: Field-based contingent valuation methods provide estimates of WTP for LNS for pregnant/lactating women (LNS-P&L) and for children 6-24 mo of age (LNS-child), and for their traditional alternatives. Experimental auctions provide incentive-compatible estimates of WTP for LNS-P&L (Ghana) and for LNS-child (Burkina Faso). Results: Average hypothetical WTP at baseline for LNS-child (one 20g sachet) was approximately US$0.39 (Ghana), US$0.23 (Burkina Faso) and US$0.20 (Malawi-DOSE). Average hypothetical WTP at baseline for LNS-P&L (one 20g sachet) was approximately US$0.61 (Ghana) and US$0.17 (Malawi-DYAD). Average experimental WTP for LNS-P&L (20g sachet) was, respectively, approximately US$0.25 (Ghana) and US$0.12 (Burkina Faso). Several household characteristics that could be used for programmatic targeting, e.g., number of children under five years of age, were associated with WTP. Conclusions: Hypothetical WTP is positive for the vast majority of respondents in all study areas and average WTP is above estimated average national production costs for all LNS products; hence, LNS products may be commercially viable. However, large proportions of respondents reported WTP below average production costs (e.g., approximately 6% of respondents reported zero WTP in the Ghana baseline) signalling the need to consider publically assisted mechanisms for reaching resource-poor households.

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.

Revised Codex Alimentarius Guidelines on Formulated Complementary Foods for Older Infants and Young Children - Better Formulations, Increased Fortification Levels and Smaller Serving Sizes to Protect Breastfeeding.

Objectives: The Codex Alimentarius guidelines on formulated complementary foods for older infants and young children have important implications for maintaining nutritional status and health and preventing malnutrition. Governments and companies rely on these guidelines, yet they were outdated due to the lag between advances in science and the lengthy process required to establish Codex guidance. Methods: In 2008, Ghana initiated and led revision of these guidelines, which were adopted by Codex in 2013. Results: Benefits of the revised Guidelines include: (1) Smaller recommended serving sizes to protect breastmilk intake; (2) Specific mention of essential fatty acids and their optimal ratio; (3) At least 50% RNI of essential vitamins and minerals per serving; (4) Expanded scope of complementary foods to include small-quantity lipid-based nutrient supplements and multi-nutrient supplements; (5) Processing techniques to minimize or reduce anti-nutrients and trans-fatty acids. Conclusions: The revised guidelines help countries to develop national regulations covering all forms of formulated complementary foods and provide updated guidance for formulating good quality foods used for infants and young children, particularly in developing countries.

Dietary Diversity is a Predictor of Acute Malnutrition in Rural but Not in Urban Settings: Evidence from Ghana.

Aims: To document the relationships between child dietary diversity and acute malnutrition (wasting) in urban and rural Ghana, controlling for maternal, child and household socio-demographic characteristics. Study Design: Cross sectional survey Place and Duration of Study: Urban and rural Ghana, between September and November 2008. Methodology: The analysis uses data from the 2008 Ghana Demographic and Health Survey. Data on children aged 6-36 months (n = 1,187) and their mothers who provided reports of child food consumption were analysed. The mother reported the child’s consumption of 16 food types/groups in the 24 hours prior to the survey. A value of 1 was assigned for each food group consumed, and these were summed to create the dietary diversity score (DDS). Logistic regression was used to investigate the relationship between DDS and childhood wasting. Results: Among rural children, but not urban children, higher DDS was associated with a significantly lower likelihood of wasting after controlling for child, maternal, and household characteristics. A one-point increase in DDS was associated with an 11% reduced odds of being wasted (OR = 0.89, 95%, C.I. 0.80 - 0.99). There was also an interaction effect with a higher likelihood of wasting predicted by lower DDS when maternal BMI was low. Conclusion: Dietary diversity has a modest but statistically significant association with acute malnutrition in rural but not in urban Ghana. Interventions to combat acute malnutrition in rural settings should include efforts to promote the consumption of a variety of food groups.