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.

The Cost of Home Delivery Schemes for Lipid-based Nutrient Supplement Products: A Policy Experiment from Rural Malawi.

Objectives: Public policy makers may play a role in promoting products demonstrated to be efficacious. Home delivery reduces households’ out-of-pocket costs of accessing these products; however, home delivery may be expensive, especially in rural areas. This paper provides evidence based on a home-delivery scheme undertaken by the International Lipid-Based Nutrient Supplements (iLiNS-DOSE) Project in rural Malawi. Methods: Estimates of home delivery costs for lipid-based nutrient supplements (LNS), including product procurement, transportation, staffing and storage costs, are based on those faced by the iLiNS-DOSE Project. A cost model was developed and used to run a hypothetical five-year policy experiment to provide LNS to 60% of the approximately 12,000 young children aged 6-24 months. LNS is delivered bi-weekly to all children in the targeted age bracket; older early-enrollees and young late-enrollees would not receive the full 18-month intervention. Results: Total cost of the hypothetical five-year intervention would be approximately US$3.3m. Cost per treated-child is US$69; cost per fully-treated-child is US$89. 63% and 21% of the total cost is attributable to product purchases and personnel costs, respectively. Conclusions: Home delivery of LNS products brings the private costs of procuring them to zero. However, the cost of procurement, storage and weekly home delivery of these products, shouldered by the public sector in our example, can be large relative to other product delivery mechanisms. Changes to intervention protocol (target population, frequency of delivery, etc.) will affect costs. The expected health and other benefits associated with each proposed intervention strategy should be compared to these costs to set priorities.

Urinary Excretion of 8-isoprostane-F2α, a Biomarker of In vivo Lipid Peroxidation and Oxidative Stress, is Increased in Pregnant Ghanaian Women Taking 60 mg Iron Compared to 20 mg Iron and Multiple Micronutrients.

Objectives: To compare the effects of 3 different iron-containing supplements on 8-isoprostane- F2α, a subclinical indicator of oxidative stress, in pregnant women in Ghana. Methods: Pregnant women were randomly assigned to receive one of the following 3 interventions: Fe/FA: 60 mg iron and 400 μg folic acid capsule, MMN: 20 mg iron and 18 micronutrients capsule, or LNS: 20 mg iron and multiple micronutrients in a lipid-based nutrient supplement as part of the International Lipid-based Nutrient Supplement trial. We measured urinary 8-isoprostane-F2α and creatinine, to calculate 8-isoprostane-F2α: creatinine ratio in a subsample of 217 women at <20 wk and 36 wk gestation. Results: The overall effect of intervention group on mean (± SE) 8-isoprostane-F2α: creatinine at 36 wk was significant (p=0.04). The significant pairwise comparison was between the Fe/FA group (1.87±0.12 ng/mg creatinine) and the MMN group (1.48±0.09, p=0.02). The LNS group (1.64±0.10) was not significantly different from either of the other two groups. Conclusions: Our findings suggest that an increase in oxidative stress may occur with daily 60 mg iron compared to 20 mg iron with multiple micronutrients among pregnant women in Ghana.

Supplemental feeding with ready-to-use therapeutic food in Malawian children at risk of malnutrition.

The study was a controlled, comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi. Being at risk of malnutrition was defined as weight-for-height <85%, but >80% of the international standard. A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food (RUTF) (n=331) or micronutrient-fortified corn/soy-blend (n=41) for up to eight weeks. The primary outcomes were recovery, defined as weight-for-height >90%, and the rate of weight gain. Children receiving RUTF were more likely to recover (58% vs 22%; difference 36%; 95% confidence interval [CI] 20-52) and had greater rates of weight gain (3.1 g/kg.d vs 1.4 g/kg x d; difference 1.7; 95% CI 0.8-2.6) than children receiving corn/soy-blend. The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the standard fortified cereal/legume-blended food.