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Research Projects

Shoulder to Shoulder and Hombro a Hombro, along with the government of Honduras and our academic and research partners, engage in major research projects. Utilizing our extensive database, infrastructure, and community relationships, we conduct research in women’s health, children’s health, nutrition, water quality, and public health.

Recent and Ongoing Research Projects 


Mejorando la Alimentación de Niños en Intibucá (MANI) I-IV
Improving the Nutrition of Children in Intibucá


Due to the high rate of poverty in the rural area of Intibucá, Honduras, diets are limited and often result in malnutrition leading to disease, stunting, and impairment of cognitive development among children. In order to address these concerns, Shoulder to Shoulder, with the help of The Mathile Institute for the Advancement of Human Nutrition, created the MANI program. Currently in its fourth iteration, MANI aims to improve health outcomes for children under 6 in Intibucá, Honduras by providing a micronutrient supplement. Each iteration of MANI used lessons learned in the previous version to fine-tune the delivery and targeting processes. The ultimate goal of MANI is to reach all children under 6 in Honduras by integrating the program into the Honduran Ministry of Health’s (MOH) nutritional screening program.

Principal Investigator: Greg Reinhart, PhD., Dr. Ana Palacios, Richard Buten, PhD., Kate Clitheroe, MPH, Dr. Jeffrey E. Heck

Funding OrganizationThe Mathile Institute for the Advancement of Human Nutrition

MANI IV, June 2016 – August 2017

Summary: Based on the success of MANI I-III, the fourth iteration of MANI aimed to increase the spread of the nutrition supplements by including the majority of children age 6 mo to 6 years in three of the organization’s seven municipalities with a goal of including 2,830 children for 12 months.  San Marcos de la Sierra and parts of Colomoncagua, both included in the study, are considered to be some of the most impoverished areas of Honduras.  Additionally, the study is fully integrated into the existing healthcare system by utilizing permanent health promoters for distribution of the nutrition supplement and quarterly anthropometric measurements.  The study also includes a small sample of children (n=213) who are monitored more closely for changes in hemoglobin and analysis of complementary feeding practices.

Preliminary Results/Progress: Anthropometric measurements include an average of 4,300 children every 3 months in 100+ communities.  Approximately 2,830 children per month receive Chispuditos.  Over 35% of these children were stunted at baseline (HAZ<-2SD) and 13.8% underweight (WAZ<-2SD).  Almost thirty six percent of children in sample (n=213) had low hemoglobin (<11g/dL).

MANI III, July 2012 – June 2013

Summary: Based on parent and child acceptance of Chispuditos and positive health indications from MANI II, MANI III continued the distribution of Chispuditos to children aged 6 months to 5 years. Because strong, positive results were seen in MANI II for children with low hemoglobin levels (iron deficiency anemia) or low Weight-for-Age Z-scores (WAZ), MANI III used a qualification requirement. All children with a hemoglobin level below 11 g/dL or a WAZ below -2 qualified to receive Chispuditos until their hemoglobin level or WAZ were above the cutoffs for two consecutive measurements.

In addition to addressing the immediate micronutrient deficiencies present in the community, MANI III was structured to serve as a pilot program to demonstrate a cost-effective, national model for integrating an under-five nutrition program into MOH services. MANI III community workers worked closely with MOH workers. All MANI meetings were set to coincide with the Atención Integral a la Niñez en la Comunidad(AIN-C) meetings, a nationwide program run by the MOH.

Major Results/Lessons Learned: Over the twelve month period of MANI III, health screenings were performed on 2,688 individual children and 1,514 children received Chispuditos at least once.  It was learned that a mechanism is needed to increase attendance at preventive health screenings and that keeping community health volunteers engaged and maintaining good community relations is essential. Additionally, with the presence of many layers of non-governmental organizations and MOH programs offering similar or complementary services, mutually beneficial collaboration is possible.  While difficult to integrate fully into existing MOH programs, this discord could be mitigated by obtaining co-sponsorship by MOH for future programs.

MANI II, September 2010 to December 2011

Summary: Building upon the knowledge gained from MANI I, MANI II tested the health impacts of a corn- and soy-based micronutrient supplement called Chispuditos among children between the ages of 6 months and 5 years. The Concepción municipality included a Randomized Community Trial, where for one year the intervention group received Chispuditos and vouchers for sugar and milk, and the control group received only vouchers for milk and sugar (once the intervention period was complete, families in the control group received Chispuditos for one year). Five other municipalities, Santa Lucía, Magdalena, Camasca, San Antonio, and parts of Colomoncagua, made up the program area. Children in these communities received Chispuditos for one year but did not receive vouchers.

Nearly 3,000 children and their caregivers attended monthly meetings where they heard educational talks and were weighed, measured, tested for anemia and other biomarkers. Additionally, health promoters conducted a series of qualitative surveys and a number of in-depth home interviews.

Major Results/Lessons Learned: Improved outcomes for hemoglobin at the 12 month mark, and improved morbidity at 12 month mark. Compared with children 0-84 months in the same region that did not receive Chispuditos, monthly incidences of diarrhea and acute bronchitis were reduced by 78% (p<.01) and 73% (p<.01) respectively. Product usage and compliance was markedly increased from MANI I, with nearly all children enjoying Chispuditos.

MANI I, November 2008 to March 2010

Summary: MANI I assessed the impact of an integrated educational and feeding intervention delivered to children between the ages of 6 to 24 months. MANI I examined children’s weight; length; cognitive and gross motor development; dietary behaviors; folate, iron, zinc and vitamin A status; food security and morbidity (respiratory and diarrheal disease) outcomes in the communities of Santa Lucia, Magdalena and San Antonio. Approximately 18 communities were randomized to a control or intervention group, with approximately 150 children in each group.

Children in the intervention communities received a lipid-based nutritional supplement (LNS) called Plumpy’doz®, vouchers for milk and sugar, and a nutrition education intervention once per month for 12 months. The children in the control communities received vouchers for milk, sugar, fruits and vegetables, and a nutrition education intervention once per month for 12 months.

Major Results/Lessons Learned: All indicators were neutral or positive, and the project design was successful. However, compliance was low due to many children expressing a strong dislike for the peanut flavor of the supplement. For MANI II, Plumpy’doz® was replaced with a soy-based supplement to increase compliance.


Surveillance for Viral Respiratory Infections in Rural Honduran Children:
Evaluation of Characteristics and Etiologic Spectrum of Influenza Virus and Other Respiratory Viruses:
Acute respiratory infections in Honduran Children/ Infecciones Respiratorias Agudas en Niños Hondureños


Principal Investigator: Elizabeth P. Schlaudecker, M.D., Cincinnati Children’s Hospital Medical Center

Abstract: A prospective sentinel clinic surveillance study to determine the viral etiologies of Acute Respiratory Infections (ARIs) in a rural Honduran population of children less than five years of age who present to local clinics with fever and respiratory symptoms of less than five days duration. We intend to recruit 500 children over a 12 month period. A questionnaire will assess age, sex, medical history, breastfeeding history, signs and symptoms, risk factory, and geographic setting. Clinical data will be recorded and rapid influenza tests will be performed on a subset of patients. Nasopharyngeal samples will be obtained via swab and shipped to the US. We expect to obtain unique data on viral etiologies of ARI in this population, including clinical characteristics, risk factors, and seasonality of each. We will also assess rapid influenza tests and the PrimeStore buffer in this setting.

Funding organization: U.S. National Institutes of Health-Fogarty International Center for the Advanced Study in the Health Sciences

Additional collaborator: Cincinnati Children’s Hospital Medical Center

Time period: January 2010 to January 2011


Please contact us if you are interested in conducting research or engaging in a long-term project in our area.