Feasibility and Acceptability of a Supplementary Food with Added Fish Oil and Choline for Undernourished Pregnant Women in Sierra Leone

Maternal ready-to-use supplementary foods (M-RUSF) have been shown to improve birth outcomes among undernourished pregnant women. Docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and choline have been hypothesized to further improve gestational duration and cognitive development. The primary objective of this study was to determine the acceptability and feasibility of a new formulation of M-RUSF, referred to as MRUSF+, that included fish oil, containing about 400 to 500 mg DHA and EPA, and 550 mg choline among pregnant women in the Pujehun District of Sierra Leone. Both the control and the experimental supplementary foods contained 18 g of high quality protein and 580 kcal, with generous amounts of all essential micronutrients. The ration size was 100 g/d. Both intervention and control recipes were locally produced using peanut paste by the Project Peanut Butter Factory in Freetown, Sierra Leone. The fish oil was added to the M-RUSF+ after all the grinding had been accomplished to limit degardation. The study used a 2x2 crossover design to assess the acceptability of the M-RUSF and M-RUSF+ formulations. Pregnant women were assigned to one of two sequences of foods: either M-RUSF+ followed by M-RUSF, or M-RUSF followed by M-RUSF+. Each food was given for one week. Fifty-one pregnant women were enrolled (day 0), with data collection occurring on days 3, 7, 10 and 14 after enrollment. At each visit, women returned the packets, either empty or partially consumed. Acceptability was assessed at all follow-up visits based on overall consumption, likeability, and adverse events reported. Consumption of M-RUSF and M-RUSF+ averaged 99%. The likability scores averaged 4.8 and 4.9 out of 5 for M-RUSF and M-RUSF+, respectively. For 85/90 visits during which M-RUSF+ was being consumed and 77/83 visits during which M-RUSF was being consumed, the foods were rated with a likability score of 5. Adverse events, defined as diarrhea, vomiting or rash were infrequent (<7%) and showed no significant differences. These results suggest that both M-RUSF and M-RUSF+ are acceptable and feasible for use among pregnant women in the Pujehun District, Sierra Leone.