Home Fortification with a Small-quantity, Lipidbased Nutritional Supplement to Improve Complementary Feeding and Child Nutritional Status in Kasenga (DR Congo).

Objectives: To address the high prevalence of anemia and chronic malnutrition (71% and 43% among children <5 respectively), UNICEF and CDC supported the Ministry of Public Health to develop an integrated IYCN pilot program in October 2012, which includes the distribution of a small-quantity, lipid-based nutrition supplement (SQ-LNS), through the routine health system. The program targets 16,500 children 0-12 months and their mothers. Methods: The program involves i) monthly individual and group IYCN counseling by trained health workers and volunteers, and ii) a monthly distribution of SQ-LNS (locally known as Kulabora) to children 6-12 months through the health system, for daily consumption. Formative research was conducted to generate culturally acceptable key counseling messages and product branding. Routine health system reporting and bi-annual Lot Quality Assurance Surveys (LQAS) are used for program monitoring. Results: After 10 months of intervention, LQAS data showed 65% of mothers received the Kulabora at the last monthly health center visit, 53% received IYCN counseling at this visit, and additionally 55% received counseling by volunteers at home. Routine monitoring data reports that 3,100 women have enrolled in the program and approximately 2,000 children receive Kulabora monthly. Results from two rounds of LQAS show improvements in several IYCN indicators. LQAS data has allowed for targeted corrective action and further formative work will be used for program strengthening. Conclusions: Formative research has been important for program success, and program implementation is possible even in difficult settings. The impact assessment in October 2014 will inform a possible scaling up of the program.

Formative Work to Design the Packaging of a Lipid-based Nutrient Supplement for a Home Fortification Program in the Democratic Republic of Congo (DRC) .

Objectives: To determine a culturally appropriate product name and package design that would communicate important usage instructions for a lipid-based nutrient supplement (LNS) for a target population with diverse languages and low literacy. Methods: Formative work was conducted in two locations in Katanga region, DRC: Mabaya, a rural village and Kipushi, a peri-urban area. In each site, focus group discussions with parents of children aged 0-24 months (3 with mothers, and 1 with fathers) were conducted. Additionally, two key informant interviews with mothers and health workers were conducted in each location. Two sets of 7 images, one for each LNS sachet in the strip, were tested to assess perceptions of use. Different color options and product names were tested to identify culturally appropriate packaging. Results: The majority of participants read the different images on the multi sachet strip as a story line. Participants retained the main messages that the strip should convey: Optimal child feeding and care, product use, target group and potential product benefits. All participants recognized the mother and children in the images as "Congolese". Green and brown were identified as suitable colors for the packaging and were associated with qualities such as growth, and healthy development. The names Kulazuri (eating well) and Afiabora (good health) were preferred. A combination of the first two name proposals "Kulabora" (eating better) was decided upon. Conclusions: The results from this formative assessment were used to finalize the design of the LNS product, which is currently being distributed in Kasenga health zone.

Establishment of a Regional Iodine Resource Laboratory and External Quality Assessment Program at the Kazakh Academy of Nutrition.

Objectives: The need for and lack of iodine resource laboratories in Central and Eastern Europe led to an agreement between the Centers for Disease Control and Prevention (CDC) and UNICEF for developing a regional iodine reference laboratory at the Kazakh Academy of Nutrition (KAN). Objectives included conducting reliable iodine measurements, KAN capacity strengthening, operating an external quality assurance (EQA) program, and self-sustainability. An underlying aim was ensuring quality laboratory data for management and decision-making of iodine disorder elimination programs. Methods: Creation of the laboratory at KAN was undertaken through technical support, training, funding, and material resources from CDC and UNICEF. Initial activities included building a fully-functioning laboratory, developing partnerships, and creating and operating a website and EQA program. Later activities included a landscape analysis, harmonized guidelines, an inaugural workshop attended by 17 regional laboratories, and a business sustainability plan. Results: The KAN reference laboratory was established and an operational plan is being implemented that will ensure sustainability. The plan includes contracts with the Kazakh government for multiple micronutrient analyses in four surveys, and fee-based trainings and assessments for regional laboratories as provided for Serbia, Kyrgyzstan, and Moldova. Participation in at least one EQA round by 78% of regional laboratories and consistent participation from 11/18 labs indicates that KAN assistance was well received. Conclusions: An up-to-date, high-quality reference laboratory and resource center for iodine assessments, led by technical experts capable of managing reliable iodine measurements in salt and urine and coordinating an EQA service for national iodine laboratories, has been established in the region.

Nutrition Survey Toolkit for Improved Micronutrient Surveys.

Objectives: The Survey Toolkit, developed by the U.S. Centers for Disease Control and Prevention and hosted by the Micronutrient Initiative, provides epidemiological support and guidance through standardized tools to countries for the assessment and monitoring of population micronutrient status and interventions. An important component of micronutrient programs is periodic surveys of micronutrient status and coverage of interventions. Execution of such surveys can be improved through use of tools and materials for planning, organizing, training and educating, implementing, and reporting of results. Methods: The toolkit offers a web-based, publicly accessible compilation of over 200 qualitative and quantitative survey tools. Tools were collated from various sources such as subject-matter experts, relevant organizations, and journal articles pertinent to the assessment of micronutrient deficiencies in populations, or were specifically created for inclusion. A user-friendly interface and search function enable users to identify tools needed for their specific task. The toolkit is currently being revised and a second edition is expected to be publicly released in 2015. Results: Tools include sample size calculators; lists of equipment and supplies; budget templates; specimen collection, processing and storage procedures; training materials, data collection templates, and survey report outlines. Additionally, examples of how the tools have been used in real-world settings are included. Conclusions: The Nutrition Survey Toolkit can help improve the validity and efficiency of surveys of vitamin and mineral deficiency and related interventions.