Adherence and acceptability of community‐based distribution of micronutrient powders in Southern Mali

Abstract

Home fortification with micronutrient powders (MNP) has been shown to reduce anaemia, with high overall acceptability and adherence, but there is limited evidence from West Africa. Around 80% of children younger than 5 years are anaemic in Mali, and new interventions are needed. This paper reports on the adherence and acceptability of a community‐led MNP intervention targeting children aged 6–59 months in Southern Mali. The MNP were delivered by a multidisciplinary group of community volunteers using community‐based preschools, cooking demonstrations, and traditional communication networks to promote MNP, nutrition, hygiene, and child stimulation. The MNP were delivered alongside early childhood development interventions and seasonal malaria chemoprevention. Adherence and acceptability were evaluated through two cross‐sectional surveys in 2014 and 2016 and a qualitative evaluation in 2015. Over 80% of parents reported ever having given MNP to their child, with 65% having given MNP for four or more days in the last week. Likely contributors to uptake include: perceived positive changes in the children following MNP use, the selection of a food vehicle that was already commonly given to children (morning porridge or bouillie) and the community driven, decentralized and integrated delivery approach. These findings support recommendations from recent reviews of MNP implementation to use community‐based delivery approaches and behaviour change components.

Micronutrient powder programs: New findings and future directions for implementation science

“…Interesting findings on complication of concurrently setting up two systems for distribution Attention is required to improve access and support continued use-frontline workers are key to support the latter (e.g. they developed a way to bypass the vouchers) related to continued use, as it helped address supply issues, answer questions, discuss issues and provide continued reinforcement (D'Agostino et al, 2019;Locks et al, 2019;Roschnik et al, 2019;Tumilowicz, Habicht, et al, 2019;Tumilowicz, Vossenaar, et al, 2019).…”

“…The social and behaviour change strategy should include nonhealth workers/volunteers-it is important not only to work with health workers or volunteers that are present in the community but also to ensure that other respected members of the community are aware, supportive and can provide basic information about MNP and how to provide it to children. The best example of this was described for the program in Mali (Roschnik et al, 2019) where the ECD platform was used to introduce MNP in the community and a multidisciplinary group of community volunteers were involved, which had actually been a suggestion from women that were asked for suggestions for program design.…”

“…15 per month without specifying the days, whereas others recommend daily use until finished. The idea of the former was that it will be less likely that caretakers get discouraged by a sense of failure when they have forgotten a dose, whereas there are also reports of daily use being easier to remember (Roschnik et al, 2019).…”

“…It also reveals the resourcefulness and commitment of health workers who can find solutions to logistical problems when they have the flexibility to do so.Distribution schemes can be adapted to circumstances-the WHO and Home Fortification Technical Advisory Group recommended frequency of dosing of MNP is 90 sachets, one per day, over a period of 6 months, which would result in an average daily intake of 50% of the RNI. However, programs may choose alternative dosing schemes in case that better fits their circumstances, such as the provision for daily consumption during 4 months outside of the malaria season(Roschnik et al, 2019).…”

Lessons learned from implementing the pilot Micronutrient Powder Initiative in four districts in Ghana

“…Since then, the efficacy of MNPs have been investigated or demonstrated in several other randomized trials in Ghana [ 12 – 15 ]. For reducing anemia and micronutrient deficiencies in young children, MNPs have been distributed in the context of pilot interventions in many countries [ 16 , 17 ] such as Ethiopia [ 18 ], Mali [ 19 ], Peru [ 20 ], Rwanda [ 21 ], and Uganda [ 21 ].…”