(P17-016-23) Implementation Research To Explore the Feasibility of a Balanced Energy Protein Supplementation Program in Bangladesh

Objectives: Balanced energy protein (BEP) supplementation is contextually recommended by WHO in undernourished settings, but few programs exist. We conducted formative research to explore how BEP supplementation might be delivered and received in a rural Bangladesh context in preparation for an effectiveness trial to inform future programs.

Methods: A ready-to-eat, packaged, lipid-based BEP product (containing rice, lentils, and milk powder and fortified with 18 micronutrients) was designed and locally manufactured for daily antenatal use. The acceptability and feasibility of distributing this product in an effectiveness study was assessed via formative research in Gaibandha District, Bangladesh.   Qualitative methods included in-depth interviews (n=46) and focus group discussions (n=8, 46 total participants) with married women of reproductive age, family members, health care providers and pharmacists. Topics were guided by an analytic framework for implementation science in nutrition and investigated attitudes and perceptions towards food consumption and supplement use in pregnancy and the acceptability and feasibility of BEP supplementation. Taste tests and the trials of improved practice (TIPs) approach were used to assess product acceptability; adherence was assessed over a two-week period in 16 women.

Results: The BEP product was viewed as acceptable in taste, consistency, and packaging; adherence was high (81.9%), and women suggested adherence support such as SMS reminders. Most women said they shared the product with a family member to try out its taste. Participants outlined potential barriers to delivery through existing antenatal care modalities and favored home delivery as more feasible and likely to increase BEP uptake and adherence.   Counseling and promotion were viewed as critical to BEP adoption, especially to emphasize its benefits and allay expressed concerns related to large size at birth.  Finally, participants felt that demand for BEP would be extremely price sensitive; many suggested that paying for daily BEP would be a significant barrier.

Conclusions: Our findings suggest that use of BEP supplements in pregnancy would be acceptable and feasible if supported by counseling, reminders, and if delivered at home; these approaches were adopted in the design of the effectiveness trial.

Funding Sources: The Bill and Melinda Gates Foundation