Trials of Improved Practices (TIPs) to Explore Caregivers’ Practices for Childhood Nutrition and Acceptance of Novel Interventions for Moderately Wasted Children in a Dhaka Slum

Objective: 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. Design: The study was conducted between May and October 2022 in preparation for a larger trial. The first phase focused on complementary feeding, hygiene, breastfeeding, and responsive feeding practices using in-depth interviews and observations. The second phase involved counseling sessions and providing food supplements for 45 participants. Follow-up visits evaluated acceptability and challenges faced during this period. Setting: Bauniabadh slum, Mirpur, Dhaka. Participants: 65 children aged 6-24 months with moderate wasting and their caregivers. Results: Findings from IDIs 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 to MDSF (4.8±1.9) and RUSF (4.7±1.6), although median consumption was similar across all supplements (75%). Conclusion: 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.