Strengthening Implementation and Utilization of Nutrition Interventions through Research: A Framework and Research Agenda.

Objectives: Evidence-based solutions are available and there is global momentum for scaling up nutrition interventions. However, the impact of evidence-based interventions is limited by poor evidence on operational strategies for scaling up nutrition interventions. The objective of this work was to develop a framework to inform a larger research agenda around delivery and utilization of nutrition interventions. Methods: The paper draws on the deliberations of a high-level working group, a web-based econsultation, a conference of global nutrition experts and a review of the published literature. Based on these methods, the paper authors develop a framework and propose areas of research that have been quite neglected, and yet, are critical to enable better translation of global and national political momentum for nutrition into public health impact. Results: The framework includes distinct components, with embedded sub-elements: 1) the logic of results frameworks (inputs, processes, outcomes and impacts); 2) Program Impact Pathways and program theory; 3) "implementation core" elements related to midstream implementation processes; 4) contextual factors at multiple evels; 5) the enabling policy environment and governance; and 6) strategic and management capacities for commitment-building, adaptive management and sustainability. Each framework component is expandable and the overall framework is adaptable to different nutrition interventions and settings. Examples are provided from behavior change communications and micronutrient interventions. Conclusions: A systematic and complete understanding of program implementation, service delivery and coverage, using the framework and research approaches identified in this review, can strengthen successful scale-up and sustain actions for nutrition.

Academy of Science of South Africa Consensus Study on Improved Nutritional Assessment of Micronutrients: Iron.

Objectives: The academy of Science of South Africa commissioned a consensus study on improved nutritional assessment of micronutrients in the country. For iron the objectives were to, evaluate usefulness of available indicators for South Africa and other African countries facing similar challenges, review the type and quality of research information on iron status in South Africa and formulate recommendations on suitability and work required for more effective monitoring of iron status and possible gains from intervention programmes. Methods: The study was done by reviewing research that has been done in relation to iron status primarily in South Africa. Results: Haemoglobin, Serum Ferritin (SF) and transferrin receptor were the most commonly used indicators in addition to dietary intake. There was lack of consistency in the use of acute phase proteins to address infection and inflammation making interpretation of SF difficult against the background of high infection prevalence eg. HIV/AIDS, worm infestation and obesity. The study found a strong bias toward low socio-economic sectors of the population while the national food fortification programme exposes the entire population to multiple micronutrients including iron. Some studies reported that some pockets of the population may be at risk of iron overload. Conclusions: Regular monitoring across population subgroups is recommended. Standard mechanisms to correct SF for inflammation/infection should be explored for more effective monitoring of interventions. Pockets of the population with potential risk of iron overload require attention.

Acceptability of Two Lipid-based Complementary Food Supplements in a Peri-urban South African Community.

Objectives: This pilot study preceding an efficacy trial in a peri-urban South African community aimed to: 1) Evaluate the acceptability of two newly developed lipid-based multi-nutrient supplements (LNS) containing micronutrients, essential fatty acids (EFAs) with docosahexaenoic acid (DHA), arachidonic acid (ARA) and phytase (Product B), and micronutrients and EFA with no DHA (Product A). 2) Compare the acceptability in terms of "general liking" of each of the two products with that of the maize porridge commonly used by the target population. 3) Evaluate the practical feasibility of usage of the two test products. Methods: Pairs of mothers and 6-12 months old infants were enrolled in a two part study. Part 1 (n=20) was a cross-over randomized acceptability study and a five-point hedonic scale was used for acceptability evaluation (very bad=1; very good=5). Part 2 (n=41) was a two-week home-use trial followed by focus group discussions. Results: Part 1: the mean (± SD) general liking score of the mothers was 4.6±1.0 and 4.6±1.1 for products A and B, respectively; and for the infants as perceived by the mothers 3.9±1.8 and 4.2±1.6. Part 2: the mean (95% CI) adherence over two weeks was 62% (47-77%) and 65% (49-81%) for products A and B, respectively. FGDs confirmed that both these products were well accepted. Conclusions: The high general liking score and satisfactory home usage indicate that LNS containing EFAs may be well accepted in this population.

A Strategy for Scaling up Vitamin A Supplementation for Young Children in a Remote Rural Setting in Zimbabwe

Background. Vitamin A deficiency is a public health problem in Zimbabwe. Addressing vitamin A deficiency has the potential to enhance resistance to disease and reduce mortality especially in children aged 5 years.Objective. To describe a vitamin A supplementation outreach strategy implemented in one of the remote rural districts in Zimbabwe; which increased coverage after being implemented in difficult circumstances in a remote rural region.Methods. We implemented and adapted a vitamin A supplementation outreach strategy within the national immunisation days (NIDs) and extended programme of immunisation in a remote rural district in Zimbabwe. The strategy involved supplementating children at prescheduled outreach points once per month for the whole year. Despite usual operational challenges faced at implementation; this approach enabled the district to increase delivery of vitamin A supplements to young children in the district.Results. The strategy covered 63 outreach sites; with two sites being covered per day and visited once per month for the whole year. Coverage reached 71 in an area in which previous coverage rates were around 50.Conclusion. Implementing a vitamin A supplementation outreach strategy increased vitamin A supplementation coverage among children living in a remote rural region. This strategy can potentially be used by Scaling Up Nutrition (SUN) member states. However; we recommend further exploration of this strategy by others working in similar circumstances