Abstract:
In Ethiopia, home fortification of complementary foods with micronutrient powders
(MNPs) was introduced in 2015 as a new approach to improve micronutrient intakes.
The objective of this study was to assess factors associated with intake adherence
and drivers for correct MNP use over time to inform scale-up of MNP interventions.
Mixed methods including questionnaires, interviews and focus group discussions
were used. Participants, 1,185 children (6–11 months), received bimonthly 30 MNP
sachets for 8 months, with instruction to consume 15 sachets/month, that is, a
sachet every other day and maximum of one sachet per day. Adherence to distribu tion (if child receives ≥14 sachets/month) and adherence to instruction (if child
receives exactly 15[±1] sachets/month) were assessed monthly by counting used
sachets. Factors associated with adherence were examined using generalized esti mating equations. Adherence fluctuated over time, an average of 58% adherence to
distribution and 28% for adherence to instruction. Average MNP consumption was
79% out of the total sachets provided. Factors positively associated with adherence
included ease of use (instruction), child liking MNP and support from community (dis tribution and instruction) and mother's age >25 years (distribution). Distance to
health post, knowledge of correct use (OR = 0.74, 95% CI = 0.66–0.81), perceived
negative effects (OR = 0.73, 95% CI = 0.54–0.99) and living in Southern Nations,
Nationalities and People Region (OR = 0.59, 95% CI = 0.52–0.67) were inversely
associated with adherence to distribution. Free MNP provision, trust in the govern ment and field staff played a role in successful implementation. MNP is promising to
be scaled-up, by taking into account factors that positively and negatively determine
adherence
