Nutrition Research: Measuring Outcomes in the Field Panel at IFADC 2012 Patrick Webb May 2012

Main foci of Phase 1 1.Review science on nutrient needs (incl. HIV/AIDS) 2.Recommend new formulations, commodity mixes, programming approaches 3.Account for industry feasibility, cost, programming issues 4.Propose mechanisms for enhanced processes (product review/approval, purchasing/procurement, problems)

Main foci of Phase 2 1.Further consultation on science and operational realities 2.Convergence (as appropriate) with WFP, etc. 3.Food technology/processing/packaging issues 4.Analysis of costing, programming needs, field trials 5.Further enhancement of inter-institutional coordination processes (guidance, procurement approaches, etc.)

Where things stand today (i) 1.FAQR preparing field trials in Malawi and (?) 1.Feasibility/effectiveness of programming FBFs with ‘new’ (A/D) oil 2.Consumer acceptability of newly formulated products 3.Viability of new packaging/BCC, programming approaches 4.Cost-effectiveness of packaging, programming. 5.Scenario-building (cost of alternative approaches and products)

2. ILNS trials – Malawi, Ghana, Burkina Faso, Bangladesh 1. Acceptability of LNS formulations for various target groups 2. Efficacy of low‐cost formulations of LNS for 6-24m(Malawi) 3. Optimal zinc to include in LNS (Burkina Faso) 4. Efficacy of LNS for preg./lact. women (Malawi, Ghana) 5. Economic analysis of delivery systems, cost‐effectiveness e.g. Bangladesh Longitudinal, cluster-randomized design. Participants enrolled in pregnancy, followed through 36 months post-partum. Random assignment to: 1) LNS for children for 18 months, from 6-24m 2) MNP for children for 18 months, from 6-24m 3) LNS for mothers (preg./lact. 6m postpartum), and their children for 18 months, from 6-24m. 4) Control

3. Johns Hopkins (collaboration with ICDDR,B, WFP and DSM) USDA funded, 5-arm trial in Bangladesh (summer 2012):  Assess efficacy of different complementary foods on growth, body composition and development.  5,400 infants 6-18m  Treatment arms include nutrition education with 2 local Bangla recipes, WFP’s Supercereal+, Plumpy'doz®, and nutrition education only (control).

5. WFP (in collaboration with many others) 1.Malawi (LaGrone et al., AJCN): MAM treated no less effectively with CSB++ than with SPP® or peanut/soy paste. 2.Similar work in Burkina coming (comparing MAM treatment with Plumpy'Sup, CSB++, Misola, local foods + MNP). 3.Also Burkina Faso, study by ITM (Belgium) and IRSS (BF) using P’Doz® or CSB++ vs counseling for MAM treatment). 4.Proposal for MAM treatment study with Achamum in India, compared to current protocols. 5. Epicentre/MSF in Niger on preventive approaches

5. MSF and others … Source: Langendorf et al./MSF/WFP/Epicentre (2012)

Source: Langendorf et al./MSF (2012) PRELIMINARY results Goal: Assess impacts on SAM and GAM (6-23m) of different food supplement and/or cash combinations (over 16m) 1.Incidence SAM and GAM significantly less in CSB++/cash and CSB++/food than CSB++ alone. 2.Incidence of SAM and GAM not significantly different between CSB++/cash and CSB++/food or SPP®. 3. Lower incidence of SAM in CSB++ versus cash alone.

Source: Langendorf et al./MSF (2012)

1.Still much to learn about what works where. 2.Many on-going trials/studies (biological, economic, programmatic). 3.Limited cross-donor coordination of research agenda (prevention/treatment, 6-24m/0-59m, products in basket and in context, like-with-like). 4.Little or no research on how to institutionalize (standardize) effective practices, at scale. 5.Limited links to broader FTF, agriculture-nutrition agendas. Conclusions