This study used the trials of improved practices (TIPs) approach to explore complementary feeding practices among caregivers of children under two and assess the acceptance of new nutritional supplements by providing microbiota-directed supplementary food (MDSF), ready-to-use supplementary food (RUSF) and locally available food (LAF) among moderately malnourished children.

The study was conducted between May and October 2022 in preparation for a larger trial. The first phase focused on complementary feeding, hygiene, breast-feeding and responsive feeding practices using in-depth interviews and observations. The second phase involved counselling sessions and providing food supplements for forty-five participants. Follow-up visits evaluated acceptability and challenges faced during this period.

Bauniabadh slum, Mirpur, Dhaka.

Sixty-five children aged 6–24 months with moderate wasting and their caregivers.

Findings from IDI and observations revealed poor handwashing practices, with most caregivers washing only with water, and inconsistent use of soap. Only a minority boiled drinking water or cleaned utensils with soap. Responsive feeding practices were also limited, with frequent mobile phone use during feeding and lack of attention to the child. Among the three food interventions, LAF received the highest hedonic ratings across all sensory attributes, with a mean taste score of 5·7±1·4, compared with MDSF (4·8±1·9) and RUSF (4·7±1·6), although median consumption was similar across all supplements (75%).

The TIPs approach identified context-specific caregiver behaviours and feeding preferences. These findings will guide the upcoming trial and assist policymakers and program planners in developing culturally tailored interventions to address childhood malnutrition in urban slums.

Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight.

We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers’ experiences with testing recommended practices.

An urban district and a rural district in Rwanda.

Caregivers with an under- or overweight child from 6 to 59 months of age (n 136).

We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child’s health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others.

These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.