Akter, T

Alders, P

Ali, E

Allaouna, M

Delchelvarie, P

Draguez, B

Harries, A D

Manzi, M

Salio, F

Shams, Z

Soderberg, J

Vernaeve, L

Zachariah, R

English

MSF Field Research

“Plumpy’Nut” 
How acceptable is it for malnourished 
pregnant & lactating women in a slum setting 
in Bangladesh ? 
Engy Ali , Rony Zachariah, Zubair Shams, Tajmary Akter , Marcel Manzi, Lieven Vernaeve 
,Petra Alders , Jenny Soderberg ,Flavio Salio, Malik Allaouna , Bertrand Draguez  , Pascal 
Delchelvarie, Anthony. D. Harries 
Medecins Sans Frontières Brussels – Luxembourg, Bangladesh 
International Union against Tuberculosis and Lung disease, Paris, France 
London School of Hygiene and Tropical Medicine, London, UK.THAI 
BORDER 
1979 ETHIOPIA 1985
BIAFRA 1968 FAMINE
MSF experienceSUDAN 1998
NIGER 2005
ANGOLA 2002
The medical relief organization Medecins sans Frontieres 
(MSF) estimates that at least 1.5 million people are suffering 
from acute malnutrition. BANGALADESHBANGALADESH 
Pregnant & Lactating Women
Malnutrition
•  Among the highest in the 
world (30%) 
Adversely affects the health of 
the  mother
 Low birth weightKamrangirchar Slum- Dhaka 2010Population  
•  Inhabitants:  400,000
•  Area: 3.1  km²
•  Density : > 100,000/km²Urban SlumPovertyPlumpy’Nut 
Ready To Use Therapeutic Food (RUTF)
Ready to Use Therapeutic Food Composition
30%
28%
15%
25%
2%
Full fat milk (in
powder form)
Sugar
Vegetable oil
Peanut butter
Mineral Vitamin MixAfrica  - Plumpy’NutBangladesh – Lentils
How acceptable is plumpy’nut among pregnant and lactating 
mothers ?Objectives
In an urban slum setting in Bangladesh to:  
Assess the acceptability of Plumpy’Nut
among pregnant and lactating womenMethods (1)
Study Design:  Semi-structured questionnaire 
Period:  May- July 2011
Site:  Kamrangirchar Slum
Study Population:  All Pregnant/lactating women- 
Malnourished or at risk 
(6 weeks on PPN)Package of Activities Methods (2): Screening 
CommunityMethods (3): Screening 
Primary Care ClinicsMethods (4): 
Pregnant & Lactating Women
•  Severe acute malnutrition 
(MUAC <170 mm or 
nutritional oedema) 
•  At risk of malnutrition 
(MUAC <210 mm) 
•  MUAC > 220 mm
- Oedema improved 
- No medical complications
Admission Discharge 
Duration of treatment:  2- 5 months
Also offered:
•  Antenatal and postnatal care 
•  Curative care 
•  ReferralMethods (5) 
Community Mobile OutreachMethods (6) 
Health Education / Cooking DemonstrationsMethods (7):  Tracing Losses to 
Follow UpMethods (8): Plumpy’Nut (PPN) 
Questionnaire Survey
Socio-demographic information
Acceptability (Perception)
– Taste, Smell, Color, Consistency
– Side effects
– Packaging
Interviews
– 3 trained community workers (Local language)
– Pre-tested Questionnaires
Ethics approval
– MSF & Union Plumpy’Nut- Acceptable
If women did not perceive any problems of 
undesirable taste, smell, color, consistency or 
side effects anytime during the intake   Results (1) 
Characteristics
Total PLW  248
Age (years, IQR) 20 (18-24) 
Housewives 99 %
Lactating 209 (84%)
Income ($ / day) 2.5
Illiterate  30%
Duration PPN  (weeks) 15 (6-28)Results (2) : PPN -Acceptability
Total PLW  248
Package instructions not understood  102 (41%) 
Did not accept PPN 193 (78%)
Reasons for unacceptability 
– Undesirable taste
– Unwelcome smell (Peanut based smell)
– Consistency 
– Color 
– Attributed side effects:  nausea, vomiting,    
diarrhoea, abdominal distention & pain
60%
43%
13%
4%
39%
Complete rejection 12 (5%)Medicine like 
smell
25%
Peanut smell
58%
Unfamiliar 
smell
17%
Too sweet
51%
Too salty
46%
Unfamiliar 
taste
3%
Results (3) : PPN -AcceptabilityResults (4): Plumpy’Nut 
Therapeutic Value
212/ 248 (85%) 
of
Pregnant and lactating 
women perceived   
PPN to be beneficialConclusion (1)
In one of the first studies from South Asia
•  Acceptability of Plumpy’Nut in a slum setting was very low
•  Eight  in ten women do not like PPN for nutritional 
rehabilitation - a serious concern as PPN is a food product 
Need for an alternative !
•  Nutritional agencies and manufacturers need to intensify 
efforts towards developing adapted RUTF for the local 
context.Conclusion (2)
This study also highlights the important role 
of operational research in showing that it is 
not enough to continue doing 
“more of the same”Acknowledgements
Many thanks to our patients, the interviewers and the MSF  staff working in 
Kamrangirchar. 

Plumpy Nut - How acceptable is it for malnourished pregnant and lactating women in a slum setting in Bangladesh?

Plumpy Nut - How acceptable is it for malnourished pregnant and lactating women in a slum setting in Bangladesh?

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