Infant and Young Child Feeding (IYCF) Practices Improved in 2 Districts in Nepal during the Scale-Up of an Integrated IYCF and Micronutrient Powder Program

Dahal²,

Pokharel

et al. 2018

Self Cite

There is limited research on integrated infant and young child feeding (IYCF) and micronutrient powders (MNPs) programmes operating at scale, despite widespread implementation. This study uses cross‐sectional baseline ( n = 2,542) and endline ( n = 2,578) surveys representative of children 6–23 months in two districts in Nepal that were part of a post‐pilot scale‐up of a IYCF–MNP programme. Multivariable log‐binomial regression models were used to estimate prevalence ratios (PRs) for stunting (length‐for‐age z ‐score <−2), wasting (weight‐for‐length z ‐score <−2), underweight (weight‐for‐age z ‐score <−2), anaemia (altitude‐adjusted haemoglobin <110 μg/L), moderate or severe anaemia (altitude‐adjusted haemoglobin <100 g/L), iron deficiency (inflammation‐adjusted ferritin <12 μg/L), and iron deficiency anaemia (iron deficiency + anaemia [IDA]) at endline versus baseline and also to compare children in the endline survey based on frequency of mothers' interactions with female community health volunteers (FCHVs; >1× per month or monthly vs. <1× per month) and MNP coverage (1 or ≥2 distributions vs. none among children 12–23 months). Endline children were significantly less likely to be stunted than baseline children in both districts (multivariable‐adjusted PR [95% CI]: 0.77 [0.69, 0.85], P < 0.001 and 0.82 [0.75, 0.91], P < 0.001 in Kapilvastu and Achham, respectively); however, only Achham had significantly lower prevalences of underweight, moderate/severe anaemia, iron deficiency, and IDA at endline. At endline, 53.5% and 71.4% of children had tried MNP in Kapilvastu and Achham districts, respectively, consuming an average of 24 sachets from the last distribution. Frequent maternal–FCHV interactions were associated with a reduced risk of stunting and underweight at endline, whereas repeat MNP coverage was associated with reduced risk of anaemia and IDA. Future research using experimental designs should verify the potential of integrated IYCF–MNP programmes to improve children's nutritional status.

Section: Methodsmentioning

confidence: 89%

Changes in growth, anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post‐pilot scale‐up of an integrated infant and young child feeding and micronutrient powder intervention

Dahal²,

Pokharel

et al. 2018

Self Cite

“…In the Nepal pilot programme, however, 15 months into programme implementation, 57% and 44% of FCHVs in the FCHV‐delivery districts and health facility‐delivery districts, respectively, reported needing more support or disliking the added work of MNP (Jefferds et al, ). We did not assess FCHV motivation or capacity in this evaluation, but in a separate analysis from this survey population, we did find that mothers who received MNP from their FCHV were more likely to report being “very satisfied” with the performance of their FCHV (Locks et al, ), potentially due to improved motivation and quality of counselling. Future research and monitoring at the CHW level are essential to understand how the introduction of MNP affects CHW motivation and performance, as well as how this changes with the provision of adequate supervision and support, and also over time as programmes mature (Vossenaar et al, ).…”

Section: Discussionmentioning

confidence: 96%

“…Details on programme implementation from the Nepal scale‐up of the integrated IYCF‐MNP programme have been published (Locks et al, ). In brief, a cascade training approach using the UNICEF community‐based IYCF training tools (UNICEF, ), with additional modules on MNP, adapted for the Nepali context.…”

Section: Methodsmentioning

confidence: 99%

“…After a feasibility study assessed the acceptability of MNP and developed key messages and strategies for the integrated IYCF-MNP programme, a pilot programme was conducted in 2010-2011 where MNP was delivered in some districts through government-run health facilities and in other districts through female community health volunteers (FCHVs; Jefferds et al, 2015). Details on programme implementation from the Nepal scale-up of the integrated IYCF-MNP programme have been published (Locks et al, 2018). In brief, a cascade training approach using the UNICEF community-based IYCF training tools (UNICEF, 2012), with additional modules on MNP, adapted for the Nepali context.…”

Section: Introductionmentioning

confidence: 99%

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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

Dahal²,

Pokharel

et al. 2019

Self Cite

Large‐scale programmes using micronutrient powders (MNPs) may not achieve maximum impact due to limited/inappropriate MNP coverage, consumption, and use. We identify predictors of MNP coverage, maternal knowledge of appropriate use, and child MNP consumption in Nepal. A cross‐sectional survey was conducted in 2,578 mother–child pairs representative of children 6–23 months in two districts that were part of the post‐pilot, scale‐up of an integrated infant and young child feeding‐MNP (IYCF‐MNP) programme. Children aged 6–23 months were expected to receive 60 MNP sachets every 6 months from a female community health volunteer (FCHV) or health centre. Outcomes of interest were MNP coverage (ever received), maternal knowledge of appropriate use (correct response to seven questions), repeat coverage (receipt ≥ twice; among children 12–23 months who had received MNP at least once, n = 1342), and high intake (child consumed ≥75% of last distribution, excluding those with recent receipt/insufficient time to use 75% at recommended one‐sachet‐per‐day dose, n = 1422). Multivariable log‐binomial regression models were used to identify predictors of the four outcomes. Coverage, knowledge of appropriate use, and repeat coverage were 61.3%, 33.5%, and 45.9%, respectively. Among MNP receivers, 97.9% consumed MNP at least once and 38.9% of eligible children consumed ≥75% of last distribution. FCHV IYCF‐MNP counselling was positively associated with knowledge, coverage, repeat coverage, and high intake; health worker counselling with knowledge and coverage indicators; and radio messages with coverage indicators only. FCHV counselling had the strongest association with knowledge, coverage, and high intake. Community‐based counselling may play a vital role in improving coverage and intake in MNP programmes.

“…Integrating SQ‐LNS into IYCF programmes could contribute to increased political, financial, community, and human resources devoted to IYCF and may ultimately improve IYCF practices, as has been hypothesized about the integration of micronutrient powders (MNP) into IYCF programmes (Siekmans, Bégin, Situma, & Kupka, ). To date, a few integrated IYCF–MNP programmes have documented improved IYCF practices in diverse settings (Locks et al, ; Locks et al, ; Mirkovic et al, ). Only one study has assessed the impact of SQ‐LNS distributions on IYCF practices, and this study focused on results from randomized trials of SQ‐LNS where IYCF behaviour change was not part of the intervention (Arimond et al, ).…”

Section: Introductionmentioning

confidence: 99%

An integrated infant and young child feeding and small‐quantity lipid‐based nutrient supplementation programme in the Democratic Republic of Congo is associated with improvements in breastfeeding and handwashing behaviours but not dietary diversity

Nanama²,

Addo

et al. 2019

Self Cite

Integrating small‐quantity lipid‐based nutrient supplements (SQ‐LNS) into infant and young child feeding (IYCF) programmes can increase consumption of essential nutrients among children in vulnerable populations; however, few studies have assessed the impact of integrated IYCF–SQ‐LNS programmes on IYCF practices. A 2‐year, enhanced IYCF intervention targeting pregnant women and infants (0–12 months) was implemented in a health zone in the Democratic Republic of Congo (DRC). The enhanced IYCF intervention included community‐ and facility‐based counselling for mothers on handwashing, SQ‐LNS, and IYCF practices, plus monthly SQ‐LNS distributions for children 6–12 months; a control zone received the national IYCF programme (facility‐based IYCF counselling with no SQ‐LNS distributions). Cross‐sectional preintervention and postintervention surveys ( n = 650 and 638 in intervention and control areas at baseline; n = 654 and 653 in each area at endline, respectively) were conducted in mothers of children 6–18 months representative of both zones. Difference in differences (DiD) analyses used mixed linear regression models. There were significantly greater increases in the proportion of mothers in the intervention (vs. control) zone who reported: initiating breastfeeding within 1 hr of birth (Adj. DiD [95% CI]: +56.4% [49.3, 63.4], P < 0.001), waiting until 6 months to introduce water (+66.9% [60.6, 73.2], P < 0.001) and complementary foods (+56.4% [49.3, 63.4], P < 0.001), feeding the minimum meal frequency the previous day (+9.2% [2.7, 15.7], P = 0.005); feeding the child in a separate bowl (+9.7% [2.2, 17.2], P = 0.01); awareness of anaemia (+16.9% [10.4, 23.3], P < 0.001); owning soap (+14.9% [8.3, 21.5], P < 0.001); and washing hands after defecating and before cooking and feeding the child the previous day (+10.5% [5.8, 15.2], +12.5% [9.3, 15.6] and +15.0% [11.2, 18.8], respectively, P < 0.001 for all). The enhanced IYCF intervention in the DRC was associated with an improvement in several important IYCF practices but was not associated with a change in dietary diversity (minimum dietary diversity and minimum acceptable diet remained below 10% in both zones without significant differences between zones). The provision of fortified complementary foods, such as SQ‐LNS, may be an important source of micronutrients and macronutrients for young children in areas with high rates of poverty and limited access to diverse foods. Future research should verify the potential of integrated IYCF–SQ‐LNS to improve IYCF practices, and ultimately children's nutritional status.