Predictors of micronutrient powder intake adherence in a pilot programme in Nepal

Abstract

Objective: Poor adherence to recommended intake protocols is common and a top challenge for micronutrient powder (MNP) programmes globally. Identifying modifiable predictors of intake adherence could inform the design and implementation of MNP projects. Design: We assessed high MNP intake adherence among children who had received MNP ≥2 months ago and consumed ≥1 sachet (n 771). High MNP intake adherence was defined as maternal report of child intake ≥45 sachets. We used logistic regression to assess demographic, intervention components and perception-of-use factors associated with high MNP intake. Setting: Four districts of Nepal piloting an integrated infant and young child feeding and MNP project. Subjects: Children aged 6-23 months were eligible to receive sixty MNP sachets every 6 months with suggested intake of one sachet daily for 60 d. Cross-sectional surveys representative of children aged 6-23 months were conducted. Results: Receiving a reminder card was associated with increased odds for high intake (OR = 2·18, 95 % CI 1·14, 4·18); exposure to other programme components was not associated with high intake. Mothers perceiving ≥1 positive effects in their child after MNP use was also associated with high intake (OR = 6·55, 95 % CI 4·29, 10·01). Perceiving negative affects was not associated; however, the child not liking the food with MNP was associated with lower odds of high intake (OR = 0·12, 95 % CI 0·08, 0·20). Conclusions: Behaviour change intervention strategies tailored to address these modifiable predictors could potentially increase MNP intake adherence.

The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6–23 Months in Madagascar

“…We found a smaller reduction in anemia, likely due to limited MNP coverage and adherence, which has been documented in other programmatic settings [12,13,14]. One major implementation barrier affecting Fortidom was a product quality problem that arose in the first few months of the program, which resulted in an unstable product that changed in consistency, color and taste.…”

“…Strengthening interventions to enhance consumption, particularly sustained consumption, has been identified as a key challenge facing MNP programs [34]; however, few studies have assessed which aspects of program implementation are associated with MNP coverage [12] and adherence [13]. We found that attending a CHW-IYCF talk and frequent exposure to IYCF-MNP radio messages were both associated with mothers’ initial use of MNP, but only CHW exposure was associated with continued MNP use.…”

“…The Kenya study found that although only 33% of households in the intervention area purchased MNP and average consumption in intervention villages was 0.9 sachets per week, the children in intervention villages still had a significantly higher mean hemoglobin and a lower risk of iron and vitamin A deficiencies than children in control villages. In both Fortidom and the Kenya program, stronger coverage and adherence likely would have resulted in greater improvements in micronutrient status; however, it is worth noting that programs using distribution strategies other than social marketing have also encountered barriers in coverage and adherence [12,13], and ultimately had smaller improvements in micronutrient status [14] compared to efficacy trials in controlled environments [7,32]. We did not find affordability to be a significant predictor of trying or continuing to use MNPs, and 94% of mothers who knew the price of MNP thought the product was affordable.…”

“…Despite the fact that MNP programs reach millions of children each year [9], there are only a handful of studies that have assessed how to best implement programs using MNPs at scale [10,11,12,13,14,15,16]. Studies have documented the use of MNP in a variety of contexts including emergency settings [10], as part of rural food distribution programs [15], as part of integrated child health programs [11], and the sale of MNP through social marketing [17].…”

Experiences and lessons learned for programme improvement of micronutrient powders interventions

“…The vast majority of published papers report on evaluations in the context of a pilot project (Creed‐Kanashiro, Bartolini, Abad, & Arevalo, 2015; Harris et al, 2012; Jefferds et al, 2015; Korenromp et al, 2015; Loechl et al, 2009; Mirkovic, Perrine, Subedi, Mebrahtu, Dahal, & Jefferds, 2016; Mirkovic, Perrine, Subedi, Mebrahtu, Dahal, Staatz, et al, 2015; Nguyen et al, 2016; Suchdev et al, 2010, 2013; Sun et al, 2011), with the exception of Bangladesh which reports on national programmes (Afsana, Haque, Sobhan, & Shahin, 2014; Angdembe, Choudhury, Haque, & Ahmed) and three large‐scale MNP distribution in refugee camps and in emergency contexts (de Pee et al, 2007; Kodish, Rah, Kraemer, de Pee, & Gittelsohn, 2011; Rah et al, 2012). …”