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

• Authors: Kelsey R Mirkovic, US Centers for Disease Control and Prevention, Atlanta; Cria G Perrine, US Centers for Disease Control and Prevention, Atlanta; Giri Raj Subedi, Ministry of Health and Population, Kathmandu, Nepal; Saba Mebrahtu, Nutrition Section, UNICEF, Kathmandu, Nepal; Pradiumna Dahal, Nutrition Section, UNICEF, Kathmandu, Nepal; Colleen Staatz, Emory University; Maria Elena D Jefferds, US Centers for Disease Control and Prevention, Atlanta
• Journal Title: PUBLIC HEALTH NUTRITION
• Volume: Volume 19, Number 10
• Publisher: Cambridge University Press (CUP) | 2016-07-01, Pages 1768-1776
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1017/S1368980015003572
• Subjects: Health Sciences, Public Health
• Keywords: Micronutrient powders; Nepal; Infant and young child feeding; Adherence; Compliance

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.