Nutrient-Dense Meal Delivery in Partnership with Small-Scale Producers in Mumbai Urban Slums: Implementation Considerations Within a Randomized Controlled Feeding Trial

Abstract Objectives Despite the multitude of evaluations of nutrition intervention trials in low-income settings, documented practice to operate such trials is scarce. We aimed to fill this gap by outlining key steps and resources required to run a small-scale intensive feeding trial such as establishing collaborations, developing an operational infrastructure, and daily orchestration of logistics for food preparation, delivery, and administration. Methods A randomized controlled feeding trial among 223 children in urban slums of Mumbai, India was completed in 2018. We established partnerships to facilitate the acquisition and proper storage of the study intervention, biofortified and conventional pearl millet. Feeding centers (FC) were identified based on a census. Two staff per FC managed daily operations: weighing and dispensing individual portions to participants based on their group allocation, recording of leftovers and adverse events. The study team developed and standardized recipes for all menu items. Development considered staple crop and nutrient density per serving, cost and availability of ingredients, and scalability. Highly accepted recipes were included in a cyclic menu. Hot meals were prepared in partnership with the university canteen, where a kitchen coordinator was responsible for daily quality control, aliquoting, and dispensation to contracted auto-drivers for FC delivery. A certified bakery produced customized shelf stable items in bulk. Items were vacuum packed individually, labeled, and delivered to FC directly. Shelf-life was tested periodically. Results Over 26 tons of crops were procured at a cost of 25,000 USD. The cost of preparing and delivering about 30,000 fresh meals was about 15,000 USD, while the cost of approximately 60,000 shelf stable meals was about 10,000 USD. Over 15 months, we served 91,815 meals at a cost of 0.59 USD/meal in the context of a randomized controlled feeding trial. Conclusions We highlight opportunities and challenges of developing a sustainable food supply system for an intervention trial. We also outline a sustainable model for delivery of nutrient-dense meals in partnership with small-scale producers instead of establishing a centralized kitchen to facilitate advocacy and scale up. Funding Sources HarvestPlus.

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Acceptability and Willingness to Pay for a Meal Kit Program for African American Families with Low Income: A Pilot Study

Nutrients ◽

10.3390/nu13082881 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2881

Author(s):

Kaley Carman ◽

Lauren H. Sweeney ◽

Lisa A. House ◽

Anne E. Mathews ◽

Karla P. Shelnutt

Keyword(s):

African American ◽

Pilot Study ◽

Willingness To Pay ◽

Low Income ◽

Food Access ◽

African American Families ◽

Nutrition And Health ◽

Health Related ◽

The Cost ◽

Shelf Stable

Food insecurity is a persistent issue among individuals with low income and is associated with various nutrition- and health-related consequences. Creative approaches to increasing food access should be investigated as possible solutions. Meal kits, which are boxes or bags of fresh and shelf-stable ingredients for one or more meals, along with a step-by-step recipe showing how to cook each meal at home, may serve as a creative solution. Meal kits have historically been marketed to higher-income demographics. The purpose of this pilot study was to investigate the utilization, acceptability, and willingness to pay for a healthy meal kit program among African American main food preparers with children and low income (n = 36). Participants received a healthy meal kit with three recipes and ingredients, a cooking incentive, and a nutrition handout weekly for six weeks. Data were collected on participants’ use, acceptability, and willingness to pay for the meal kits and analyzed using descriptive statistics. The intervention was highly utilized, and participants reported high acceptability ratings for most recipes. After the intervention, participants were willing to pay $88.61 ± 47.47 for a meal kit with three meals, each with four portions, which was higher than indicated at baseline and similar to the cost to produce the kits. Meal kits may offer a creative solution to improving food access if affordable for families with low income.

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Lessons learnt from the rapid implementation of reusable personal protective equipment for COVID-19 in Malawi

BMJ Global Health ◽

10.1136/bmjgh-2021-006498 ◽

2021 ◽

Vol 6 (9) ◽

pp. e006498

Author(s):

Fumbani Limani ◽

David Garley ◽

Derek Cocker ◽

Priyanka Patel ◽

Pratiksha Patel ◽

...

Keyword(s):

Low Income ◽

Personal Protective Equipment ◽

Scale Up ◽

Healthcare Providers ◽

Cost Effective ◽

Protective Equipment ◽

Ongoing Training ◽

Early Implementation ◽

Worker Perceptions ◽

The Cost

The SARS-CoV-2 pandemic has challenged health systems and healthcare workers worldwide. Access to personal protective equipment (PPE) is essential to mitigate the risk of excess mortality in healthcare providers. In Malawi, the cost of PPE represents an additional drain on available resources. In the event of repeated waves of disease over several years, the development of sustainable systems of PPE is essential. We describe the development, early implementation and rapid scale up of a reusable gown service at a tertiary-level hospital in Blantyre, Malawi. Challenges included healthcare worker perceptions around the potential of reduced efficacy of cotton gowns, the need to plan for surge capacity and the need for ongoing training of laundry staff in safety and hygiene procedures. Benefits of the system included increased coverage, decreased cost and reduced waste disposal. The implementation of a reusable cotton gown service is feasible, acceptable and cost-effective in tertiary centres providing specialist COVID-19 care at the height of the pandemic. This innovation could be expanded beyond low-income settings.

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A process for developing a sustainable and scalable approach to community engagement: Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh

10.21203/rs.3.rs-15638/v3 ◽

2020 ◽

Author(s):

Rebecca King ◽

Joseph Hicks ◽

Christian Rassi ◽

Muhammad Shafique ◽

Deepa Barua ◽

...

Keyword(s):

Antibiotic Resistance ◽

Health System ◽

Community Engagement ◽

Low Income ◽

Cultural Context ◽

Scale Up ◽

International Standards ◽

Low Income Countries ◽

Small Scale ◽

Engagement Interventions

Abstract Background Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example.Methods The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed formative research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey – which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level.Results A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable.Conclusions This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context.

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A process for developing a sustainable and scalable approach to community engagement: Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh

10.21203/rs.3.rs-15638/v2 ◽

2020 ◽

Author(s):

Rebecca King ◽

Joseph Hicks ◽

Christian Rassi ◽

Muhammad Shafique ◽

Deepa Barua ◽

...

Keyword(s):

Antibiotic Resistance ◽

Health System ◽

Community Engagement ◽

Low Income ◽

Cultural Context ◽

Scale Up ◽

International Standards ◽

Low Income Countries ◽

Small Scale ◽

Engagement Interventions

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Falling Through the Cracks: The Cost of the School Day for Families Living in In-work and Out-of-work Poverty

Scottish Affairs ◽

10.3366/scot.2018.0259 ◽

2018 ◽

Vol 27 (4) ◽

pp. 486-511 ◽

Cited By ~ 1

Author(s):

Morag Treanor

Keyword(s):

Low Income ◽

Child Poverty ◽

Warning System ◽

Small Scale ◽

Children And Families ◽

Financial Costs ◽

Full Participation ◽

School Day ◽

The Cost ◽

School Costs

Poverty is known to deleteriously affect children's experience of, and success in, education. One facet of this relationship is the financial costs associated with full participation in education in what has become known as the ‘cost of the school day’. This paper draws on a small-scale longitudinal qualitative study of families living in poverty, drawn from a wider study called the ‘Early Warning System’, carried out in collaboration with the Child Poverty Action Group Scotland. The paper explores the experiences of parents in out-of-work and in-work poverty, and cycling between the two, in relation to school costs for their children and the effects this has on their wider financial situation. The findings show that families experiencing in-work poverty, especially those who have recently moved from receipt of out-of-work benefits, face the financial hurdle of not being entitled to passported benefits such as free school meals, school clothing grants, and initiatives such as schools’ subsidies of activities and trips. The longitudinal aspects of the study design allow the impacts that changes in entitlement to benefits have on families. The paper concludes that the costs of the school day can be unseen and not well understood by educators but keenly felt by children and families living in low-income and makes recommendations to mitigate this.

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Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000210 ◽

2014 ◽

Vol 84 (5-6) ◽

pp. 244-251 ◽

Cited By ~ 2

Author(s):

Robert J. Karp ◽

Gary Wong ◽

Marguerite Orsi

Keyword(s):

Low Income ◽

Energy Content ◽

Food Selection ◽

The United States ◽

United States Department ◽

Micronutrient Deficiencies ◽

Caloric Density ◽

Low Income Families ◽

The Cost ◽

The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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Planetary gentrification and urban (re)development

Urban Development Issues ◽

10.2478/udi-2019-0001 ◽

2019 ◽

Vol 61 (1) ◽

pp. 5-13 ◽

Cited By ~ 4

Author(s):

Loretta Lees

Keyword(s):

Low Income ◽

Policy Making ◽

Large Scale ◽

Urban Redevelopment ◽

Urban Transformation ◽

Small Scale ◽

Income Groups ◽

Low Income Groups

Abstract Gentrification is no-longer, if it ever was, a small scale process of urban transformation. Gentrification globally is more often practised as large scale urban redevelopment. It is state-led or state-induced. The results are clear – the displacement and disenfranchisement of low income groups in favour of wealthier in-movers. So, why has gentrification come to dominate policy making worldwide and what can be done about it?

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