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

Abstract

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.

A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda

“…If the aim is for mothers to actively seek out MNP, it is essential that they understand its health benefits. Consistent with other studies, 17,42,44,45 qualitative results from the present study showed that perceived side effects (e.g., diarrhea, vomiting) and change in taste of foods mixed with MNP were among barriers to using MNP. It has been suggested that possible changes to foods due to addition of MNP and the potential negative side effects of MNP should be acknowledged and clearly communicated to caregivers before children start getting MNP.…”

“…15,16 While MNP interventions have been shown to be efficacious in many studies, they are often conducted in controlled trials using resources that are not usually available during a national implementation or scale-up. 17 In some settings, MNP programs have thus been ineffective due, in part, to factors that may affect actual implementation. 18,19 For example, a study in Uganda 19 found that mothers cooked foods with soda ash to reduce cooking time.…”

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

“…Use of MNP is a long-term preventive intervention that requires continued and sustained practice. Programs should hence both promote new behaviours and sustained practice (D'Agostino et al, 2019) for caretakers to adopt a complex series of behaviours and maintain them (Ford et al, 2019, Locks et al, 2019, Tumilowicz, Habicht, et al, 2019. The behaviours include obtaining sachets initially and over time (coverage) and initiating and continuing to prepare and serve food with MNP to children (sustained intake).…”

“…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).…”

“…Furthermore, Lock et al also found that group and group-plusindividual counselling was related to repeat coverage and high intake, but individual counselling alone was not. This emphasizes the importance of skills-building, social support and continued positive reinforcement, which are essential for maintaining changes in health behaviour and should be provided in the community (Locks et al, 2019).…”