Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation.

Section: Resultsmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

“…In the Kyrgyz Republic, anaemia decreased by only 6.8 PP over 12 months of intervention among children aged 6–24 months who were given 30 sachets of MNP (12.5 mg iron per sachet) every 2 months for ‘flexible’ consumption as part of a large‐scale infant and young child nutrition programme (Serdula et al . ). Furthermore, about a 10 PP reduction in anaemia was realised among children 6–23 months of age living in refugee camps in Nepal after about 2 years of MNP intake (Bilukha et al .…”

Section: Discussionmentioning

confidence: 97%

“…In general, effectiveness studies for MNP that were conducted under programme conditions over a long duration (≥1 year) without provision of a food supplement to children have yielded relatively smaller magnitudes of change in haemoglobin and anaemia. In the Kyrgyz Republic, anaemia decreased by only 6.8 PP over 12 months of intervention among children aged 6-24 months who were given 30 sachets of MNP (12.5 mg iron per sachet) every 2 months for 'flexible' consumption as part of a large-scale infant and young child nutrition programme (Serdula et al 2013). Furthermore, about a 10 PP reduction in anaemia was realised among children 6-23 months of age living in refugee camps in Nepal after about 2 years of MNP intake (Bilukha et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Adding multiple micronutrient powders to a homestead food production programme yields marginally significant benefit on anaemia reduction among young children inNepal

Osei

Pandey

Spiro

et al. 2015

Anaemia affects 46% of preschool-aged children in Nepal. A cluster-randomised study was conducted in rural Nepal to test whether providing micronutrient powders (MNP) in addition to enhanced homestead food production (EHFP) programme, consisting of home gardens, poultry and nutrition education, could lead to a higher reduction in anaemia compared with providing only EHFP. This sub-study enrolled 335 children aged 6-9 months into one of three groups: (1) EHFP + MNP; (2) EHFP; or (3) control. The EHFP + MNP group received 60 sachets of MNP for flexible consumption at the start and 6 months later for a total supplementation period of 11 months. The MNP contained 15 micronutrients including iron (10 mg encapsulated ferrous fumarate). Haemoglobin and anthropometry were measured at baseline and post-MNP supplementation. Mean ± SE haemoglobin concentration increased significantly in all groups, with a slightly higher but non-significant increase in the EHFP + MNP and EHFP compared with control (difference-in-differences: 4.1 g L −1 for EHFP + MNP vs. control; 3.6 g L −1 for EHFP vs. control; 0.5 g L −1 for EHFP + MNP vs. EHFP). Anaemia decreased at a slightly higher magnitude in the EHFP + MNP [51.5 percentage points (PP)] than the EHFP (48.6 PP) and control (39.6 PP), with adjusted odds ratios (95% CI) at post-supplementation of 0.52 (0.25-1.12) for EHFP + MNP and 0.69 (0.35-1.36) for EHFP, compared with control. There was no impact on child growth. Combining EHFP and MNP programmes yielded a marginally significant reduction in anaemia among children.

“…As of 2013, more than 40 countries were implementing preventive MNP interventions to improve anaemia and micronutrient status (UNICEF 2014). While the efficacy of MNP interventions to improve anaemia and iron status is well established in controlled trial settings, the public health programmatic experience is still growing (De-Regil et al 2011;Rah et al 2012;Serdula et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Predictors of micronutrient powder sachet coverage in Nepal

Jefferds

Mirkovic

Subedi

et al. 2015

Many countries implement micronutrient powder (MNP) programmes to improve the nutritional status of young children. Little is known about the predictors of MNP coverage for different delivery models. We describe MNP coverage of an infant and young child feeding and MNP intervention for children aged 6–23 months comparing two delivery models piloted in rural Nepal: distributing MNPs either by female community health volunteers (FCHVs) or at health facilities (HFs). Cross-sectional household cluster surveys were conducted in four pilot districts among mothers of children 6–23 months after starting MNP distribution. FCHVs in each cluster were also surveyed. We used logistic regression to describe predictors of initial coverage (obtaining a batch of 60 MNP sachets) at 3 months and repeat coverage (≥2 times coverage among eligible children) at 15 months after project launch. At 15 months, initial and repeat coverage were higher in the FCHV model, although no differences were observed at 3 months. Attending an FCHV-led mothers’ group meeting where MNP was discussed increased odds of any coverage in both models at 3 months and of repeat coverage in the HF model at 15 months. Perceiving ≥1 positive effects in the child increased odds of repeat coverage in both delivery models. A greater portion of FCHV volunteers from the FCHV model vs. the HF model reported increased burden at 3 and 15 months (not statistically significant). Designing MNP programmes that maximise coverage without overburdening the system can be challenging and more than one delivery model may be needed.