The label on a brand of coffee creamer sold in Laos has led to mis-perceptions of its intended use, according to a cross-sectional survey of consumers and pediatricians released on September 10, 2008 in BMJ Online First.
The Bear Brand logo features a cartoon caricature of a baby bear, held in its mothers arms in the breast feeding positions. The same logo is used on its coffee creamer product, intended for use in coffee and nutritionally inadequate for infants, as well as its infant formula products for infants six months and older.
The label also features a picture of an infant feeding bottle, which is crossed out. Additional precautions on the label include a written warning which states “This product is not to be used as breast milk substitute” in English, Thai, and Lao. However, there are high rates of illiteracy in Laos, especially in rural areas, and even then many people speak another of the 45 languages widely spoken there.
Hubert Barennes and colleagues from the Institut de la Francophonie pour la Médecine Tropicale in Laos performed a survey in response to a number of children admitted in Laos with malnutrition due to being fed the Bear Brand creamer exclusively. In the study, they hoped to determine the order of magnitude of this misconception and understand what people thought the logo meant.
The researchers interviewed 26 pediatricians working in 8 of the 17 provinces in Laos in 2006, in order to collect information about parents’ use of this brand of coffee creamer as a substitute for breast milk. They later conducted a sample survey in five representative provinces in randomly selected villages and households in 2007, to answer questions about peoples’ knowledge and use of the product.
Bear Brand coffee creamer was found to be well recognized and widely distributed. Almost half of the adults surveyed responded that they believed the product to be “good for infants” or a “replacement for breast milk.” Almost one-fifth of parents had given the product to their own young infants — this was especially true when mothers returned to work or when the mother was incapacitated or died. Almost half of the respondents did not notice the written warning or the picture of the crossed-out baby’s bottle at all. A total 12% did not understand the meaning of the cross drawn through the bottle.
The authors point out that the cartoon bear and cub may be misleading to parents, causing them to believe that this coffee creamer is suitable as a breast milk substitute, despite the contrary warnings on the label. This misinterpretation seems significant enough that the Bear Brand logo should not be used on products that are not intended for infants, say the authors. In conclusion, they point out the public health implications: “The sale of coffee creamer with this logo places the health of infants and children at risk in a developing nation that already has extreme levels of malnutrition.”
Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos
Hubert Barennes, Todisoa Andriatahina, Vattanaphone Latthaphasavang, Margot Anderson, Leila M Srour,
BMJ 2008;337:a1379
doi:10.1136/bmj.a1379
Written by Anna Sophia McKenney