Predictors of micronutrient powder sachet coverage in <scp>N</scp>epal

Jefferds, Maria Elena; Mirkovic, Kelsey; Subedi, Giri Raj; Mebrahtu, Saba; Dahal, Pradiumna; Perrine, Cria G.

doi:10.1111/mcn.12214

Cited by 33 publications

(70 citation statements)

References 17 publications

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“…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). …”

Section: Resultsmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation.

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Section: Resultsmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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“…MNP has been locally branded in Nepal as Baal Vita (translated as “Vitamins for Children”); each sachet contains 15 micronutrients including iron and zinc at ~1x the Recommended Nutrient Intake (WFP/WHO/UNICEF, ). 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, ). Beginning in late 2012, the Ministry of Health and the United Nations Children's Fund (UNICEF) began scaling‐up the integrated IYCF‐MNP programme, which as of 2016 had reached 26 out of the country's 75 districts.…”

Section: Methodsmentioning

confidence: 99%

“…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, ).…”

Section: Introductionmentioning

confidence: 99%

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

Locks

Dahal²,

Pokharel

et al. 2019

Maternal & Child Nutrition

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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.

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“…Longer‐term use was better in the FCHV model, but the FCHVs reported increased work burden, which should be addressed as the programme is scaled‐up (Jefferds et al . ).…”

Section: Monitoring Programme Implementationmentioning

confidence: 97%

“…; Jefferds & Flores‐Ayala ; Jefferds et al . ; Osei et al . ) fortified complementary food (Bauserman et al .…”

mentioning

confidence: 99%

Special nutritious solutions to enhance complementary feeding

Pee

2015

Maternal & Child Nutrition

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Predictors of micronutrient powder sachet coverage in Nepal

Cited by 33 publications

References 17 publications

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Experiences and lessons learned for programme improvement of micronutrient powders interventions

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

Special nutritious solutions to enhance complementary feeding

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