Acceptability of Lipid-based Nutrient Supplements (LNS) for Infants and Young Children in Guatemala

The study was carried out in two communities in the Suchitepéquez Department in partnership with Funcafé, a NGO subcontracted by the Ministry of Health (MOH) to implement the Programa de Extension de Cobertura (PEC) in Suchitepéquez. PEC provides basic medical care in remote communities that have limited access to MOH's health centers. This acceptability study was conducted in communities where PEC was implemented by Funcafé.

The children were randomly selected from a list of beneficiaries of PEC served by Funcafé and invited to participate. Eligibility for participation in the study was determined at the time of recruitment in the homes of potential participants, by administration of a screening questionnaire by study staff.

All caregivers who completed the home use trial were invited to participate in the FGD. Funcafé staff members (i.e. Institutional facilitators, Community facilitators and Community monitors) were randomly selected from the employee roster and potential participants were invited to participate in FGD using a standard recruitment script.

The study was approved by the IRB of the University of California, Davis. Unawareness of whether a child was intolerant of peanut or milk products did not prevent participation, but the child was provided with a small dose of LNS (~5 g) and asked to remain under observation by study staff for at least one hour. After this initial test, caregivers were also given the project's mobile phone number to call in case there were any symptoms during the next few hours. No allergic reactions or other adverse effects were observed or reported in any subject.

During the Test-feeding trial, the order of the versions of LNS tested was randomly determined for each subject. At the first home visit after recruitment (Day 0), the primary caregivers of the children were given an orientation about LNS. During the orientation, background data (e.g., socioeconomic and demographic information) were collected using a structured questionnaire and the experimental procedures were practiced, including initial tasting of the LNS mixed with food and completion of the tasting questionnaire, but no data on amount consumed or organoleptic preferences were recorded. The second home visit was Test Day 1, during which the actual tasting was recorded. All children were apparently healthy and had not eaten any food (including breast milk) during the previous hour, but during that time water was allowed. Caregivers were asked to provide 40 g (~3 tablespoons) of the complementary food they usually give to their children that was available at home, to which 10 g (~2 teaspoons) of LNS were mixed. The mother/caregiver of the child was asked to consume one teaspoon of the LNS + food mixture (~ 5 g), and then to feed the rest (~ 45 g) to the child after the mixture was re-weighed. The mother or caretaker rated the mixture's color, aroma, flavor and consistency based on her own opinion, and her perception of the infant's degree of liking using a 5-point pictorial hedonic scale (i.e., dislike very much, dislike, neutral, like, like very much). In order to test the different flavored LNS a third home visit was conducted (Test Day 2). The same procedures described above for Test Day 1 were followed on Day 2, but each child tasted the other LNS flavor. No overall or organoleptic (i.e., color, odor, taste and consistency) preferences were assessed on Day 2. Thus, total participation in this phase lasted 3 days, including the initial orientation day. At each test-feeding day, we collected data on infant's health (i.e., nasal discharge, cough, difficulty breathing, fever, diarrhea, vomit/nausea, ear infection, and any other symptom) and any possible reaction to the test meal.