Formative Research to Guide Successful Scale-up of Micronutrient Powder Programmes: Lessons Learned from a 4 Country Comparison

Abstract

Objectives: Micronutrient Powders (MNP) have been shown to reduce anaemia among young children and are reportedly easy-to-use for home fortification of complementary foods. Many countries are considering implementing MNP. However, to facilitate optimal implementation, formative research must be conducted to address country-specific household barriers such as cultural practices, knowledge and beliefs. 1. Compare findings from 4 countries where formative research was conducted to inform MNP protocols and communication materials. 2. Evaluate tools and share lessons learned to inform country-specific MNP programmes. Methods: In Rwanda, Zambia, Cameroon and Lao PDR, focus groups were conducted with caregivers; and individual caregivers, health workers and community leaders were interviewed on IYCF knowledge, attitudes and practices, anaemia and beliefs. Home-based MNP trials then followed children 6-23 months over 14-30 days with caregivers interviewed to evaluate acceptability and adherence at baseline, midpoint and endline. Formative research tools, MNP and IYCF communication and training materials were tested. Results: Practices varied considerably by country and important barriers identified, particularly regarding complementary feeding. Age at introduction, suitable food vehicle availability and consistency were frequently not concordant with recommendations. For example, in Rwanda porridge was too liquid and in Laos sticky rice too dense for delivering MNP. Whereas, home fortification was universally accepted and tools developed were highly usable. Conclusions: Formative research was indispensible as knowledge, attitudes and practices varied widely between countries with implications for usage, training and communication materials. Tailoring global guidelines using our research tools will help ensure optimal development of country-specific protocols and ultimate effectiveness of MNP home fortification scale-up.