Comparison of Methods to Assess Adherence to Small-quantity Lipid Based Nutrient Supplements (SQ-LNS) and Dispersible Tablets among Young Burkinabe Children Participating in a Community-based Intervention Trial
Souheila Abbeddou *
Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA.
Sonja Y. Hess
Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA.
Elizabeth Yakes Jimenez
Nutrition Program, Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, New Mexico, USA.
Jérôme W. Somé
Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA and Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
Rosemonde M. Guissou
Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
Zinewende P. Ouedraogo
Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
Stephen A. Vosti
Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA.
Jean Bosco Ouedraogo
Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
Kenneth H. Brown
Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Adherence to supplementation provided during an intervention trial can affect study outcomes. We compared different approaches for estimating adherence to SQ-LNS and dispersible tablets in a randomized clinical trial in Burkina Faso to evaluate concordance among results and factors associated with reported non-adherence.
Methods: 2453 children (9-18 mo) were randomly assigned to receive daily 20 g SQ-LNS with varying contents of zinc and a dispersible tablet (0 or 5mg zinc). During weekly home visits, reported adherence to SQ-LNS and tablets was collected through caregiver interview and disappearance rate was calculated based on unused packages. In a randomly selected subgroup (n=192), 12-h home observations were completed when children were 11 and 16 mo of age, to assess supplement consumption.
Results: Average daily reported SQ-LNS and tablet adherence was 97%±6%. SQ-LNS and tablet disappearance rate also showed high weekly adherence (98%±5%). By contrast, home observation found that only 68% and 58% of children at 11 and 16-mo, respectively, received SQ-LNS during the observation periods (Rho=0.06, P=0.294 reported vs. observed), and fewer (36 and 28%) received a tablet at 11 and 16-mo (Rho=0.11, P=0.05). Fever, diarrhea, malaria, vomiting and loss of appetite reduced significantly reported consumption of SQ-LNS and, to a lesser extent, tablet (P<0.0001).
Conclusions: Discrepancies among observed and reported results suggest possible over-reporting of adherence to products and/or that consumption occurs outside the 12h home observation period. Child morbidity may change child acceptance or caregiver perceptions regarding the suitability of supplementation. Better methods are needed to assess adherence in community supplementation trials.