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Locks LM, Dahal P, Pokharel R, Joshi N, Paudyal N, Whitehead RD, Chitekwe S, Mei Z, Lamichhane B, Garg A, Jefferds ME. 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. Matern Child Nutr 2020; 15:e12712. [PMID: 31622040 PMCID: PMC6856851 DOI: 10.1111/mcn.12712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Lindsey M Locks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Nutrition Section, United Nations Children's Fund (UNICEF) Headquarters, New York, New York, USA
| | - Pradiumna Dahal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Rajkumar Pokharel
- Nutrition Section, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | | | - Naveen Paudyal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Ralph D Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers of Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Zuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers of Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bikash Lamichhane
- Child Health Division, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - Aashima Garg
- Nutrition Section, United Nations Children's Fund (UNICEF) Headquarters, New York, New York, USA
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers of Disease Control and Prevention, Atlanta, Georgia, USA
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Ford ND, Ruth LJ, Ngalombi S, Lubowa A, Halati S, Ahimbisibwe M, Mapango C, Whitehead Jr RD, Jefferds ME. Predictors of micronutrient powder sachet coverage and recent intake among children 12-23 months in Eastern Uganda. Matern Child Nutr 2019; 15:e12792. [PMID: 31622041 PMCID: PMC7199021 DOI: 10.1111/mcn.12792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/21/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
We evaluated predictors of micronutrient powder (MNP) sachet coverage and recent intake using data from a cross-sectional survey representative of children aged 12-23 months in Amuria district, Uganda. In June/July 2016, caregivers were interviewed 12 months after implementation of an integrated MNP and infant and young child feeding pilot (N = 761). Logistic regression described predictors of (a) high-MNP sachet coverage (received at least 60 sachets/6 months) and (b) recent intake (consumed MNP during the 2 weeks preceding the survey) among children who had ever received MNP and had complete data (N = 683). Fifty-nine percent (95% Confidence Interval [CI] [53.8, 64.2]) of children had high-MNP sachet coverage, and 65.4% (95% CI [61.0, 69.9]) had recent intake. MNP ration cards (Adjusted Odds Ratio [AOR] 2.67, 95% CI [1.15, 6.23]), organoleptic changes to foods cooked with soda ash (AOR 1.52, 95% CI [1.08, 2.14]), having heard of anaemia (AOR 1.59, 95% CI [1.11, 2.26]), knowledge of correct MNP preparation (AOR 1.89, 95% CI [1.11, 3.19]), and current breastfeeding (AOR 2.04, 95% CI [1.36, 3.08]) were positively associated with MNP coverage whereas older child age (18-23 vs. 12-17 months) was inversely associated with coverage (AOR 0.32, 95% CI [0.23, 0.50]). MNP ration cards (AOR 2.86, 95% CI [1.34, 6.09]), having heard an MNP radio jingle (AOR 1.40, 95% CI [1.01, 1.94]), knowledge of correct MNP preparation (AOR 1.88, 95% CI [1.04, 3.39]), and the child not disliking MNP (AOR 1.90, 95% CI [1.13, 3.22]) were positively associated with recent intake. Interventions that increase caregiver knowledge and skills and focus on older children could improve MNP coverage and recent intake.
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Affiliation(s)
- Nicole D. Ford
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgiaUSA
- McKing Consulting Corp.FairfaxVirginiaUSA
| | - Laird J. Ruth
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgiaUSA
- McKing Consulting Corp.FairfaxVirginiaUSA
| | - Sarah Ngalombi
- Nutrition DivisionUganda Ministry of HealthKampalaUganda
| | - Abdelrahman Lubowa
- School of Food Technology, Nutrition and BioengineeringMakerere UniversityKampalaUganda
| | - Siti Halati
- Nutrition SectionUnited Nations World Food ProgrammeKampalaUganda
| | | | - Carine Mapango
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgiaUSA
| | - Ralph D. Whitehead Jr
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgiaUSA
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers of Disease Control and PreventionAtlantaGeorgiaUSA
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Locks LM, Reerink I, Tucker Brown A, Gnegne S, Ramalanjaona N, Nanama S, Duggan CP, Garg A. 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. Nutrients 2017; 9:E581. [PMID: 28590440 DOI: 10.3390/nu9060581] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 11/25/2022] Open
Abstract
This study assesses the impact of an integrated infant and young child feeding (IYCF) and micronutrient powder (MNP) intervention on children’s risk of anemia and IYCF practices in Madagascar. Quantitative baseline and endline surveys were conducted in representative households with children 6–23 months from two districts, where an 18-month IYCF-MNP intervention was implemented. Relative risks comparing children’s risk of anemia and maternal IYCF knowledge and practices at baseline versus endline, and also at endline among MNP-users versus non-users were estimated using log-binomial regression models. 372 and 475 children aged 6–23 months were assessed at baseline and endline respectively. Prevalence of anemia fell from 75.3% to 64.9% from baseline to endline (p = 0.002); the reduction in the risk of anemia remained significant in models adjusting for sociodemographic characteristics (ARR (95% CI): 0.86 (0.78, 0.95), p = 0.003). In endline assessments, 229 out of 474 (48.3%) of children had consumed MNPs. MNP-users had a lower risk of anemia (ARR (95% CI): 0.86 (0.74, 0.99), p = 0.04) than non-users, after controlling for child’s dietary diversity and morbidity, maternal counseling by community-health-workers, and sociodemographic characteristics. Mothers interviewed at endline also had greater nutrition knowledge and were more likely to feed their children ≥4 food groups (ARR (95% CI): 2.92 (2.24, 3.80), p < 0.001), and the minimum acceptable diet (ARR (95% CI): 2.88 (2.17, 3.82), p < 0.001) than mothers interviewed at baseline. Integration of MNP into IYCF interventions is a viable strategy for improving children’s consumption of micronutrients and reducing risk of anemia. The addition of MNP does not negatively impact, and may improve, IYCF practices.
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