Helen Keller International

Introduction Malnutrition among young children remains high in West Africa, with stunting (34.5%), wasting (6.7%), and micronutrient deficiencies (62%). Fortified, locally and Commercially Produced Complementary Foods (CPCFs) can help fill nutrient gaps, yet local production faces systemic challenges. Objective To assess the opportunities and constraints facing CPCF producers in Ghana, Niger, and Nigeria, and identify strategies to strengthen local production. Methods A literature review screening over 120 mixed sources mapped evidence on demand, production capacity, supply chains, costs, and regulation. Findings informed qualitative research. Five focus group discussions and 46 in-depth interviews were conducted with CPCF producers, regulators, financial institutions, and institutional buyers. Data were coded thematically using QDA Miner Lite. Results Producers reported operating below capacity and facing aflatoxin contamination. In Ghana, underutilization was linked to irregular demand and costly packaging. Nigerien producers highlighted obsolete machinery, high input prices such as premix and reliance on savings groups. Nigerian firms had invested in modern systems but faced volatile input prices, high energy costs, and frequent inspections. Regulatory compliances were hindered by limited awareness, high compliance costs, widespread illiteracy, and informal businesses. Consumer demand was shaped by affordability and trust, with imported brands often preferred. Adaptive strategies included single-serving sachet packaging, WhatsApp marketing, NGO-supported machine rehabilitation, bulk raw material purchasing, and producers and suppliers’ contract for quality. Conclusion CPCF producers demonstrate resilience but face systemic barriers. Coordinated action through targeted Small and Medium Enterprises (SME) financing, aflatoxin control, streamlined certification process, and demand creation is essential to unlock the potential of CPCFs in West Africa.

Azithromycin mass drug administration (MDA) to ages 1-59 months can reduce childhood mortality; however, more evidence is needed to support targeting a narrower age range of 1-11 months. This trial assesses the efficacy of azithromycin MDA to 1-11-month-old children in reducing mortality in a real-world setting with integration of vitamin A delivery within the established Child Health Days platform in Burkina Faso. Mortalite Infantile Reduite par l'Administration de Masse de l'Azithromycine is a double-masked, cluster-randomised, placebo-controlled trial in Child Health Days communities in Burkina Faso. Primary healthcare centre catchment areas (Centres de Santé et de Promotion Sociale (CSPS)) were randomised 2:1 to deliver biannual azithromycin or placebo for 1-11-month-old children. Birth history data at the study endpoint were used to calculate mortality rates and compare between groups. From September 2021 to January 2024, 201 709 children in 303 CSPS received azithromycin and 100 959 children in 158 CSPS received placebo, with an overall treatment coverage of 85%. Mortality rates were 2.6 (95% CI 2.1 to 3.1) deaths per 1000 person-years in the azithromycin arm and 2.5 (95% CI 1.8 to 3.2) per 1000 person-years in the placebo arm. There was no significant difference in the mortality rates by arm (incidence rate ratio: 1.04; 95% CI 0.75 to 1.46; p value 0.80). There were 16 non-serious adverse events and no serious adverse events recorded during the trial. This trial demonstrates that azithromycin MDA for child survival can be scaled up and integrated into existing child health programmes but was unable to demonstrate an effect of azithromycin distribution on infant mortality. These findings indicate future policy decisions should consider treatment delivery to the larger age group of children up to 5 years old. The trial was funded by the Bill and Melinda Gates Foundation (INV-005395). NCT04716712.

BackgroundMicronutrient deficiencies among pregnant women contribute to adverse maternal and neonatal outcomes. Multiple micronutrient supplementation (MMS) has proven its superiority when compared to the standard iron and folic acid (IFA) supplementation for maternal and infant morbidity and mortality. The Government of Nepal is exploring the scale-up of MMS, but first requires evidence such as on its adherence and acceptability. The objective of this study, thus, is to generate this needed evidence.MethodsThe Non-inferiority Assessment of Maternal Adherence to Supplements, a Trial on the Effects of Multiple Micronutrient Supplementation (NAMASTE-MMS) in Nepal study is a three-arm, parallel, non-inferiority cluster-randomized controlled trial (c-RCT) assessing how well pregnant women adhere to and accept different types of supplements: MMS in blister packs or bottles versus IFA in blister packs. In one of Nepal’s seven provinces, Lumbini, the longitudinal NAMASTE-MMS study is being implemented across 120 health facilities (clusters), enrolling 2640 pregnant women into one of three arms: IFA-blister, MMS-blister, or MMS-bottle. The primary outcome is adherence to 180 supplements during pregnancy, measured by tablet counts with a non-inferiority margin of 13%. Secondary outcomes include comparisons of adherence between the two MMS arms and utilization of Antenatal Care (ANC), both potentially impacted by type of packaging. Exploratory outcomes include comparisons of adherence as well as the degree of acceptability to supplementation during early and mid pregnancy and post-partum.DiscussionEvidence generated from this study and three related mixed-methods implementation research studies will help the government in its potential scale-up of MMS supplementation during pregnancy and lactation.Trial registrationNCT06327646 (ClinicalTrials.gov, March 18, 2024 registered).

Abstract Introduction: This case study evaluates Fueling Bright Futures , an integrated approach involving enhancing school gardens, improving the menu of canteen, and providing nutrition education in three public schools in Cavite, Philippines. The intervention addresses both undernutrition and overnutrition, tackling the double burden of malnutrition among Filipino schoolchildren. Methods This mixed-methods study was conducted in three public elementary schools in Cavite, Philippines. Baseline and endline assessments (Apr 2024, Feb 2025) included canteen menu audits (per DepEd Order 13), garden inventories, and focus groups with staff and administrators. Effectiveness and scalability were evaluated using the Intervention Scalability Assessment Tool (ISAT) in participatory workshops with policymakers and stakeholders. Qualitative data from all sessions were coded and thematically analyzed via NVivo14 and mapped to ISAT domains. Results All the schools made substantial gains in garden output, dietary diversity, and the nutritional quality of canteen offerings. The number of “green” menu items increased sharply (School A: 2—11 per week), whereas the number of “red” foods decreased substantially (School B: 10—2 per week; School C: 13—4). Canteen staff adjusted recipes to use more garden produce, although some packaged snacks persisted. Barriers included limited resources, irregular garden supplies, time constraints, and outside processed food vendors. Strong leadership and community participation elevated acceptability, but infrastructure and sustainability challenges persisted. Conclusions Improving and integrating school gardens, improved canteen menus, and staff training can enhance school food environments in resource-limited schools. Success requires strong leadership, partnerships, practical planning, and sustained resources. Ongoing investment and collaboration are critical to building nutrition-friendly school environments that support students’ health and well-being.

Background/Objectives: Antenatal multiple micronutrient supplementation (MMS) improves birth outcomes more effectively than iron and folic acid (IFA) supplementation alone. However, the acceptability of MMS among pregnant individuals, a critical factor for adherence and program success, remains poorly defined and inconsistently assessed. This narrative review proposes a comprehensive definition of “acceptability” in the context of nutritional supplementation and evaluates the evidence on the acceptability of MMS compared to IFA in low- and middle-income countries (LMICs). Methods: We conducted a systematic literature search across Embase, Medline, and Scopus to identify studies (including grey literature) reporting on acceptability-related outcomes for MMS versus IFA among pregnant individuals. Studies exploring dimensions such as organoleptic properties, ease of consumption, side effects, cultural appropriateness, and socioeconomic factors were included. Results: Out of 1056 screened studies, five informed a novel multi-dimensional definition of acceptability. Six studies assessed acceptability-related characteristics. MMS was generally accepted across most organoleptic domains. Most studies reported fewer or comparable adverse side effects for MMS as compared to IFA. Studies consistently reported more perceived benefits for MMS than IFA. Facilitating factors included trust in health professionals, free provision, and family support. Barriers included poor taste or smell, fear of side effects, misconceptions, cost, and lack of family support. Conclusions: Antenatal MMS is widely acceptable in LMICs. Addressing socio-cultural, sensory, and socioeconomic factors is essential to increase uptake and adherence. This review provides a clear, standardized definition of acceptability to guide future research and inform effective program design.

Policy changes require stakeholder buy‐in, therefore, the timely delivery of tailored evidence provided to all stakeholders involved in policy discussions is important. This paper reports the evidence generation and delivery processes undertaken in Burkina Faso, Nigeria, and Senegal in support of bouillon fortification discussions. We identified stakeholder‐specific evidence needs, tapped existing data and new data to generate that evidence, and packaged and delivered it to stakeholders. Evidence needs included the levels of micronutrient inadequacy (with/without existing and other hypothetical fortification programs), the potential contributions of bouillon fortification to reduce micronutrient inadequacy and (for some micronutrients) child mortality, the cost and cost‐effectiveness of bouillon fortification programs, and the contribution of bouillon to total sodium intake. Evidence on technical and commercial issues was also required. Stakeholder‐specific understanding and ownership of evidence was essential; achieving both required continual interaction and trust. New bouillon evidence delivery channels were developed in each country and linked to existing decision‐making bodies. A shared vocabulary and understanding of issues and evidence, and the continual innovative redelivery of evidence, were critical to success; persistence and innovations in evidence delivery paid dividends. Concrete policy changes regarding bouillon fortification were secured in Nigeria; policy discussions continue in Burkina Faso and Senegal.

Abstract Learners with deafblindness – the combined loss of vision and hearing – present an extremely diverse profile, demanding highly individualised educational approaches. Given that a one-size-fits-all education is insufficient, the creation and implementation of personalised learning plans (PLPs) are crucial for providing a tailored roadmap to achieve educational success and unlock their full potential. This article outlines the critical components of successful PLPs, emphasising the necessity of accessible communication, the strategic use of assistive technology and comprehensive transition planning to foster equity and inclusion for this population. It is also noted that the neurological involvement in a vast majority of deafblind individuals under the age of 10 positions the condition as much as a medical condition as a sensory disability. [1] The ultimate goal of the PLP is to establish an inclusive learning environment that allows students to achieve their full potential. Data relevant to successful PLP components and implementation were selected and extracted through a multi-faceted, ecological approach involving: (1) Direct learner engagement and assessment: Direct interaction and ongoing assessment of learners with deafblindness across varied environmental and social settings to identify functional strengths, needs and preferred communication modalities. (2) Collaborative goal planning: Working collaboratively with educational teams to plan, monitor and adjust individualised learning goals within the framework of the PLPs. (3) Inter-professional liaison: Systematic consultation and collaboration with families, therapists and other relevant professionals (e.g., orientation and mobility specialists and low-vision specialists) to gather comprehensive qualitative and quantitative data and ensure ecological validity of the learning strategies.

Food waste is a global problem with social, nutritional and environmental implications affecting the sustainability of the food chain. In Tanzania, food waste coexists with food and nutrition insecurity, however, its extent and its nutritional impact remain unclear. This study sought to quantify food waste from selected fresh produce in Dar es Salaam's retail markets and estimate the associated nutrient losses per-vendor per day. Data was collected from three districts namely: Kinondoni, Ubungo and Temeke. A total of 108 fresh food vendors collected their daily food waste of pre-selected fresh food produce items namely bananas, tomatoes, potatoes, carrots, cabbage and amaranth for seven days. These waste samples were measured daily on a weighing scale and recorded. Measurement of 108 samples daily for 7 days resulted in a total of 756 sample recordings obtained. Data in mean kilograms of waste was then calculated using standardized conversion factors to nutrient compositions using Tanzania food composition tables to estimate nutrient losses embedded in wasted fresh food. The data was further presented as recommended intakes for additional context. Of the selected foods, bananas produced the highest amount of waste with a daily mean of 13.9 kg ± 13.1 (SD) per-vendor, tomatoes produced a daily mean of 10.1kg ± 6.9 (SD); potatoes 8.5kg ± 6.3 (SD); cabbage 4 kg ± 3.0 (SD); carrots 3.4 kg ± 1.6 (SD), while amaranth was the least wasted with a daily mean of 0.2kg ± 1.0 (SD) wasted. Food wasted at the retail level of the Dar es Salaam food supply contained 3,643 Kcal, 93.4 g protein, 147 g dietary fiber, 6,429 µg vitamin A, 1,371 µg folate, 66.3 mg iron and 20,936 mg potassium per-vendor per day indicating notable nutritional losses embedded in food wasted at the retail level of the Dar es Salaam food supply.