Zinc-biofortified flour may be a cost-effective approach to improve zinc status of populations in low-resource settings. The success of biofortification programmes is subject to acceptability and uptake by consumers. This study explored community leaders’ and community members’ (n = 72) experiences and attitudes towards the flour provided during a cluster randomised controlled trial of zinc biofortified wheat in rural Pakistan (BiZiFED2). Focus group discussions (n = 12) were conducted and thematic analysis applied using an inductive, semantic, contextualist approach. Five themes were identified: (1) Contribution to food security; (2) Better sensory and baking properties than local flour; (3) Perceived health benefits; (4) Willingness to pay for the flour; and (5) Importance of trusted promoters/suppliers. Although the participants were blind to whether they had received control or biofortified flour, referred to collectively as “study flour”, the results indicated that the study flour performed well in terms of its taste and bread making qualities, with no adverse reports from participants in either arm of the BIZIFED2 RCT. Participants suggested that they would buy the biofortified wheat if this was available at a fair price due to perceived health benefits, reporting positive sensory characteristics and cooking attributes when compared to the flour available in the local markets. Overall, there was a positive reception of the programme and flour among the participants, and members of the community hoped for its continuation and expansion.

Almost 40 years after the adoption of the International Code of Marketing of Breast‐Milk Substitutes (‘the Code’) in Mexico, noncompliance persists. In other countries, smartphone applications for reporting Code noncompliance have proven effective. This study aimed to identify key features for the design of a public health surveillance app to monitor Code breaches and the barriers and facilitators to its use by parents and stakeholders. Semi‐structured interviews (n = 34) and focus groups (n = 14) with key stakeholders (n = 81), including parents and caregivers, health care personnel, representatives of academia, civil society organizations and government entities, were conducted between August and December 2023. Transcripts were analysed in MAXQDA 20 software using grounded theory ‘lite’, which emphasizes the construction of categories and concepts to explore and structure participant perspectives. Four categories were constructed from the coding process: (a) knowledge and perspectives about the Code; (b) attitudes towards reporting Code breaches and any subsequent repercussions; (c) stakeholders perspectives on monitoring the Code and (d) perspectives on the app. Mexican stakeholders supported the development of an app and associated website to monitor the Code, indicated a willingness to report breaches, and believed that a national committee and state bodies should oversee surveillance and monitoring activities of the Code. Adapting legal measures with appropriate sanctions and making infractions public were recommended. Developing an app assisted with artificial intelligence could aid the establishment of a national monitoring system for the Code, make infractions public, promote societal participation, and drive regulatory changes for commercial milk formula marketing.

Background: In Pakistan, 24.3% of women of reproductive age and 19.5% of children aged under five living in rural areas are zinc deficient (1). Z |