Experiences and lessons learned for delivery of micronutrient powders interventions

Abstract

An effective delivery strategy coupled with relevant social and behaviour change communication (SBCC) have been identified as central to the implementation of micronutrient powders (MNP) interventions, but there has been limited documentation of what works. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” three working groups were formed to summarize experiences and lessons across countries regarding MNP interventions for young children. This paper focuses on programmatic experiences related to MNP delivery (models, platforms, and channels), SBCC, and training. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that most countries distributed MNP free of charge via the health sector, although distribution through other platforms and using subsidized fee for product or mixed payment models have also been used. Community‐based distribution channels have generally shown higher coverage and when part of an infant and young child feeding approach, may provide additional benefit given their complementarity. SBCC for MNP has worked best when focused on meeting the MNP behavioural objectives (appropriate use, intake adherence, and related infant and young child feeding behaviours). Programmers have learned that reincorporating SBCC and training throughout the intervention life cycle has allowed for much needed adaptations. Diverse experiences delivering MNP exist, and although no one‐size‐fits‐all approach emerged, well‐established delivery platforms, community involvement, and SBCC‐centred designs tended to have more success. Much still needs to be learned on MNP delivery, and we propose a set of implementation research questions that require further investigation.

Predictors of micronutrient powder (MNP) knowledge, coverage, and consumption during the scale‐up of an integrated infant and young child feeding (IYCF‐MNP) programme in Nepal

“…Our four outcomes of interest were thus MNP coverage (ever received MNP), repeat MNP coverage (receipt of MNP ≥2 times among mothers of children aged 12–23 months who had received MNP at least once), maternal knowledge of appropriate use (based on seven knowledge questions), and high child intake adherence (consumption of ≥75% of last MNP distribution). There is no consensus on how to define intake adherence for MNP programmes (Reerink et al, ). In Nepal, mothers were expected to receive two boxes (60 sachets) of MNP during each distribution; however, many reported receiving only one box (30 sachets) at the last distribution.…”

“…Of the 65 countries implementing programmes with MNP in 2015, 25 had initiated national or subnational programmes (UNICEF, ). Most programmes distribute MNP free of charge through the health sector, usually as part of ongoing infant and young child feeding (IYCF) programmes (Reerink et al, ). The free health sector MNP programmes, which usually distribute MNP through routine health facility visits, health facility visits and community outreach, or biannual child health days, have coverage rates ranging from 32% to 83% based on each programme's definition of coverage (Jefferds et al, ; Korenromp et al, ; Reerink et al, ), and intake adherence (defined by each programme) of 35–88% (Jefferds et al, ; Korenromp et al, ; Reerink et al, ; World Vision, ).…”

“…The free health sector MNP programmes, which usually distribute MNP through routine health facility visits, health facility visits and community outreach, or biannual child health days, have coverage rates ranging from 32% to 83% based on each programme's definition of coverage (Jefferds et al, ; Korenromp et al, ; Reerink et al, ), and intake adherence (defined by each programme) of 35–88% (Jefferds et al, ; Korenromp et al, ; Reerink et al, ; World Vision, ). Notably, the majority of evaluations reporting coverage and intake data have come from pilot interventions in small areas with more resources than would be available during national or subnational implementation (Jefferds et al, ; Korenromp et al, ; Reerink et al, ; World Vision, ). A recent MNP expert consultative group concluded that implementation research from programmes operating at scale (defined as reaching a large population with long‐term delivery infrastructure) is urgently needed to inform MNP programmes globally (Nyhus Dhillon et al, ).…”

Recomendaciones para intervenciones con suplementos de hierro: lecciones aprendidas en un ensayo comunitario en cuatro regiones del Perú

“…Existe evidencia de que las plataformas complementarias y establecidas, a través de agentes comunitarios o programas de otros sectores como desarrollo social o agricultura, basadas en comunidad, son efectivas para la distribución oportuna de suplementos (27) . Los programas exitosos de suplementación muestran un gran esfuerzo por la implementación de una estrategia de comunicación para el cambio de comportamiento a diferentes niveles y una minuciosa estrategia de mercado social (29) . Las intervenciones con productos nuevos requieren que los planificadores, el personal de salud, los agentes comunitarios, las madres, la comunidad y otros actores sociales aprendan y actúen de forma nueva (21) , sin embargo, muchas veces solo se focaliza la estrategia de comunicación en la madre.…”

“…Una premisa básica para iniciar la estrategia de comunicación para cambio de comportamiento es definir las audiencias o niveles, establecer los objetivos de comunicación para cada nivel, desarrollar las estrategias comunicativas para lograr los objetivos y evaluar la efectividad de la estrategia de comunicación (29) . Un aspecto clave en la estrategia de motivación e información, es la consejería a la madre sobre el uso del suplemento, dado que a simple vista el uso de los MNP resulta sencillo; sin embargo, preparar los MNP de forma adecuada y que el niño lo consuma requiere de un conjunto complejo de comportamientos de la madre e interacción entre ella y el niño.…”