How BU Researchers Are Improving Global Child Malnutrition, One Supplement at a Time
Dr. Lindsey Locks, an assistant professor of Health Sciences at Sargent College and of Global Health at the School of Public Health, has received a grant from Edesia Nutrition for a trial she
will lead with Dr. Seth Adu-Afarwuah of the University of Ghana, testing whether the way a child’s
nutritional supplement is packaged changes how much of it the child actually receives. The trial
runs in Ghana Health Service child welfare clinics in the Northern Region, and it puts the burden of
proof on the package rather than on the caregiver: the question is whether the supplement can fit a
routine that already exists, not whether caregivers can rearrange their lives around the supplement.
SQ-LNS are daily nutrition supplements designed for infants and young children living in food-
insecure settings. They deliver essential fatty acids, vitamins and minerals alongside the family diet,
and have been shown to reduce childhood wasting, stunting, and anemia. Unlike a ready-to-use
therapeutic food (RUTF), which treats children who are already severely wasted, SQ-LNS is
preventive — it is given to children who are growing normally in order to keep them that way. That
distinction has consequences. RUTF appears on the WHO Model Essential Medicines List for
Children and on many national lists; SQ-LNS is on almost none. Where SQ-LNS reaches children at
all, it usually does so through non-governmental organizations (NGOs) or time-limited UNICEF
programs rather than through national health systems.
A child welfare clinic in Kumbungu District, Northern Ghana, one of the two districts where the trial will run
The research focuses on the practical implementation of SQ-LNS through its packaging. Dr. Adu-
Afarwuah and the Ghana-based study team, headquartered in Tamale, chose the study districts,
Kumbungu and Tolon, and built the trial around the child welfare clinic visits the health service
already runs. Sixteen facilities will compare a weekly and a daily format, enrolling roughly 505
caregiver-child pairs beginning in September. Dr. Jacqueline M. Lauer, a clinical associate professor
in BU’s Global Nutrition Lab, is in Ghana this month for the study team’s training. Both formats
deliver the same 28-day supply and the same daily nutritional content — either 28 single-serve 20-
gram sachets, or four resealable pouches holding seven days each. What differs is what the
packaging asks of the person using it. A daily sachet requires no decision: the packet is the dose. A
seven-day pouch is fewer units for a health system to ship, store and hand out, but it asks the
caregiver to measure out each day’s portion and reseal the rest. The trial is registered as NCT07129109.
Rather than measure children’s growth, the trial measures how much supplement comes back.
Caregivers return what is left at their next clinic visit and the study team weighs it, and at two
points caregivers are asked to open the package and dispense one day’s dose while an enumerator watches. If the weekly pouch performs as well as the daily sachets in caregivers’ hands, health
systems gain a format that is simpler to supply at scale without costing children anything.
“It’s a narrow question, and that’s the point,” says Dr. Locks. “Everything about this supplement
works except the part where it reaches a child every day for months on end. The question isn’t
whether a mother can manage a seven-day pouch. It’s whether the pouch is worth what it asks of
her, and the only way to find that out is to ask her.”
Lindsey Locks at Edesia Nutrition in Rhode Island.
The project is funded by Edesia Nutrition, a US-based nonprofit dedicated to addressing global
malnutrition. Edesia manufactures both RUTF and SQ-LNS, including Plumpy’Nut, which it makes
under license from Nutriset. After the U.S. Agency for International Development (USAID), which
funded global nutrition programs, ceased operations in July 2025 and its remaining programs
moved to the State Department, Edesia has since expanded beyond manufacturing into building
coalitions to deliver life-saving aid. The innocent foundation and Groupe Nutriset are also partners
in the trial.
Dr. Locks’ partnership with Edesia grew out of earlier research in global nutrition. She, Dr. Lauer and
Dr. Davidson Hamer previously received funding through Boston University’s Center on Forced
Displacement to study the use of SQ-LNS in displaced communities. The project introduced the
researchers to Edesia and laid the groundwork for their current collaboration.
“Hold the two sachets next to each other and they look like the same product. One is on the WHO
Left, ready-to-use therapeutic food, the WHO-recommended outpatient treatment for severe acute malnutrition. Right, a small-quantity lipid-based nutrient supplement (SQ-LNS), which when provided daily can prevent malnutrition. SQ-LNS has not yet been added to most African or Asian essential medicines lists.
essential medicines list and moves through national systems. The other has almost nowhere to go,”
says Dr. Locks. “That gap isn’t about the evidence. We’ve built a pathway for treating a child who is
already severely malnourished, and we haven’t built one for keeping a child from getting there.”
Dr. Locks directs BU’s Global Nutrition Lab with Dr. Lauer and Dr. Hayford M. Avedzi, a clinical
assistant professor and epidemiologist trained at the University of Ghana and the University of
Alberta. The lab works with partners in Ghana, India and Zambia.
She also serves as Chair of the Global Nutrition Council of the American Society for Nutrition, where
she shapes the society’s policy work and global programming, and has written about what the
contraction of global nutrition funding means for the programs left standing.
