Exploring Factors Influencing Mothers' Adherence to a Micronutrient Powder Program for Young Children in Nepal Open Access

Staatz, Colleen (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/q811kj79x?locale=en
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Abstract

Background: Micronutrient malnutrition presents a large burden of disease among young children worldwide, and children ages six months to two years in resource-poor settings are particularly vulnerable. Micronutrient powders (MNPs) can be mixed into foods given to young children and are an efficacious intervention for preventing iron- deficiency anemia and other micronutrient deficiencies. High levels of adherence are necessary for MNPs to improve health, but little is known about the relative importance of various factors influencing mothers' adherence to these interventions.

Objectives: This study explores the associations between mothers' knowledge and perceived positive and negative effects of MNPs and their adherence to a MNP program for young children in Nepal.

Methods: The Government of Nepal has piloted an integrated infant and young child feeding program with an MNP component, and this study examines data from preliminary monitoring surveys from the first two districts in which the program was implemented. A total of 476 of the 707 mothers surveyed had ever given the MNP to their child. Logistic regression models were used, controlling for mothers' education, to determine associations between adherence and mothers' knowledge of MNPs and recommended preparation, awareness of anemia, exposure to various behavior change communication strategies, and perceived negative and positive effects of MNPs. All results were stratified by district.

Results: The largest association by far was between perceived positive effects of the MNP and adherence. Mothers in both districts who perceived positive effects were nearly ten times as likely to have high adherence, controlling for all negative perceived effects. Perceived negative effects, mothers' knowledge of MNPs, awareness of anemia, and attending a mothers' group meeting were also significantly associated with higher adherence in one of the two districts.

Discussion: Perceiving positive effects can be an important motivating factor for mothers to continue giving MNPs, even if they perceive some negative side effects. Mothers may need to use the product for some time before perceiving positive effects, however. Behavior change communication strategies should emphasize the benefits of MNP use and support mothers to continue using the product even if no positive effects are perceived initially.

Table of Contents

Chapter 1: Introduction...1

Introduction and Rationale...1
Problem Statement...2
Purpose Statement...5
Research Questions...5
Specific Aims...6
Significance Statement...6

Chapter 2: Literature Review...8

Burden of Micronutrient Deficiencies Worldwide...8
Strategies to Combat Micronutrient Deficiencies...9
Micronutrient Powder Interventions to Date...11
Adherence to MNPs Compared to Iron Drops...13
Factors Influencing Adherence to Iron Supplementation...14
Factors Influencing Adherence to MNPs...15
Adherence to Medical Treatments in General...17
Infant and Young Child Feeding in Nepal...20

Breastfeeding Practices...20
Complementary Feeding Practices...20

Nutrition Status of Children of Nepal...21
Current Micronutrient Interventions in Nepal...23
Summary and Study Relevance...24

Chapter 3: Methods...26

Population and Sample...26

Background on Nepal...26
Health System in Nepal...27
Integrated IYCF & Baal Vita Micronutrient Powder Program...29

Research Design...35
Procedures...36
Survey Instrument...37
Data Analysis...38
Scope of the Analysis...39
IRB Consideration...40

Chapter 4: Results...41

Demographic Characteristics of the Population...41
Coverage and Ever Use of Baal Vita...43
Adherence to Baal Vita...43
Mothers' Knowledge of Baal Vita...44
Mothers' Knowledge of Baal Vita and Adherence...46
Awareness of Anemia and Iron and Adherence...47
Mothers' Exposure to Behavior Change Communication Strategies and Adherence...49
Perceived Negative Effects of Baal Vita and Adherence...50
Perceived Positive Effects of Baal Vita and Adherence...53

Chapter 5: Discussion...56

Summary...56
Mothers' Knowledge and Adherence...57
Exposure to Behavior Change Communication Strategies...58
Perceived Effects and Barriers to Using Baal Vita...59
Limitations and Strengths...61
Conclusions and Implications...63

References...66
Appendices...70

Appendix 1: Household Survey Questionnaire (English Version)...70
Appendix 2: Baal Vita Brochure (English Draft Version)...88
Appendix 3: Baal Vita Reminder Card (English Draft Version)...90

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