evidence-based blog of Filippo Dibari

Formative assessment to design the packaging of a lipid-based nutrient supplement for a home fortification program to improve the nutritional status of young children in the Democratic Republic of Congo

In Under-nutrition on September 7, 2013 at 1:35 pm


From the  Home Fortification Technical Advisory Group (HF-TAG)



The Democratic Republic of Congo (DRC) is a vast country with more than 66 million inhabitants. Despite being one of largest reserves of natural resources in the world, child survival remains of concern in DRC. Based upon the preliminary results of the 2010 MICS Survey (Multiple Indicators Cluster Survey), National rates of malnutrition are high: wasting (9%), stunting (43%) and underweight (24%). In an effort to combat malnutrition UNICEF has implemented a 3- year Infant and Young Child Feeding IYCF strategy that integrates IYCF counseling (based on the WHO Ten Guiding Principles) in the Minimum Health Package. An important component of the DRC UNICEF 3-year IYCF strategy is a pilot program that will provide counseling to pregnant women, IYCF counseling, community messages, and a small quantity (20g per day) lipid based nutrient supplement (LNS) for infants (daily for children 6-12 months of age), using the existing health care infrastructure. The pilot program will be implemented in Kasenga health zone (HZ) and pending the results of the pilot program, the enhanced IYCF program will be scaled up to other HZ’s in DRC.

The goal of the program is to improve the nutritional status of children aged 0-12 months of age in Kasenga Health zone by reducing the prevalence of anemia, vitamin A deficiency and improving infant and young child feeding practices through the delivery of key messages and the distribution of lipid based nutritional supplements (LNS) (for children 6-12 months of age). The purpose of this present document is to describe the process to design the packaging of the LNS product that will be distributed as part of the pilot project.

In October 2010 an initial formative assessment was conducted to guide the design of the proposed packaging of an LNS product, to be used in in the pilot program. A second formative assessment, conducted in June 2011, re-tested the design elements of the packaging and tested the concept of providing the LNS in a multi sachet strip. The results of this second formative study were used to finalize the package and branding of the LNS. This report presents the results of the second formative study.

The specific aim of the second formative assessment was to determine which name, color, general style, and images communicate important product-related messages and would maximize the appropriate use of the product in an area with low literacy levels.

A study protocol was developed by CDC and Nutriset describing the methodology and tools that would be used in the formative assessment. Focus group discussions (FGD) and key interviews (KI) were the primary methods chosen to collect the data.

Data was collected in two locations of Lubumbashi, Katanga region: Mabaya, a rural village and Kipushi, a peri-urban area.

Results show that the majority of the study participants read the different images on the multi sachet strip as a story line. The images were interpreted as a series of events that must happen in a child’s life to ensure that the child stays healthy and develops well. The messages of washing the child’s hands, feeding the child with breastmilk and enriching complementary foods are seen as necessary elements in order to have a playful and active child. Participants retained

the main messages that the strip should convey: child care, product use, target group, as well as potential product benefits.

All participants recognized the mother and the children in the images as “Congolese” and “African”. Green and brown were identified as suitable colors for the LNS packaging and were associated with qualities such as health, growth, and development of the child. White could add a positive association by making a link to the milk content of the product.

The participants preferred the names Kulazuri (eating well) and Afiabora (good health) for the LNS. After further discussion of the name options with the field team and UNICEF staff a combination of the first two name proposals was found “Kulabora” (eating better).

The results from this formative study were used to finalize the design of the LNS product, which is currently being distributed in Kasenga health zone.

– See more at: http://hftag.gainhealth.org/resources/formative-assessment-design-packaging-lipid-based-nutrient-supplement-home-fortification-p#sthash.MvLVxabW.dpuf

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