Ethiopian mothers' experiences with micronutrient powders: Perspectives from continuing and noncontinuing users

Abstract

As part of a formative evaluation of a micronutrient powder (MNP) trial in Ethiopia that was organized according to a programme impact pathway model, we conducted in‐depth focused ethnographic interviews with caregivers of children between 6 and 23 months who had accepted to try “Desta,” a locally branded MNP. After stratification into two subgroups by child age, respondents were randomly selected from lists of caregivers who had received MNP from government health workers between 1 and 3 months prior to the interview date. Thirty women who were either currently giving Desta to their child (“continuing users,” n = 14) or had stopped feeding Desta (“noncontinuing users,” n = 16) were purposefully recruited from both urban and rural areas in the two different regions where the trial was conducted. Interviews were recorded, transcribed and translated, and coded for both emerging and prespecified themes. On the basis of identifiable components in the caregiver adherence process, this paper focuses exclusively on factors that facilitated and inhibited “appropriate use” and “continued use.” For “appropriate use,” defined as the caregiver preparing and child consuming MNP as directed, we identified four common themes in caregiver narratives. With respect to “continued use,” the caregiver providing and child consuming the minimum number of MNP sachets over a recommended time period, our interviews spontaneously elicited five themes. We also examined caregivers' perceptions related to problems in obtaining refills. Attention to caregivers' perspectives reflected in their narratives offers opportunities to improve MNP utilization in Ethiopia, with potential application in other social and cultural settings.

Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia

“…The survey results showed that 22.9% of caregivers who stopped feeding Desta did so because they perceived that their children refused food mixed with it (Table 3). Our findings from the FES, which was conducted in a subsample of caregivers who participated in the trial (Pelto et al, 2019), provide insights for the interpretation of this result.…”

“…These findings may be attributable to a natural evolution of taste preferences. Many children in the second and third years of life enter a "neophobic" phase during which some previously liked foods are no longer accepted, and the introduction of new foods becomes difficult (Nicklaus, 2009 Pelto et al, 2019). In the FES sample, six of the nine caregivers who reported problems with child refusal of food with Desta sought advice from HEW.…”

“…Therefore, we created two intersecting streams of inquiry: (1) an examination of sequential program outcomes and their correlates using cross-sectional survey data and (2) a focused ethnographic study (FES) to investigate delivery experiences and Desta use from the perspectives of caregivers. We report on the results of the FES in a separate paper of this supplement (Pelto et al, 2019). This paper presents key findings from a population-based cross-sectional survey conducted at the same time as the FES, approximately 8 months after initiation of MNP distribution.…”

Designing an ethnographic interview for evaluation of micronutrient powder trial: Challenges and opportunities for implementation science

“…year of life as they experience periods of illness and poor appetite, and progress through developmental stages that affect feeding behaviours (G. Pelto et al, 2019). In Mozambique, we identified challenges in access to obtaining the supplement that had not been foreseen in the design and implementation of the delivery system (Tumilowicz, Vossenaar, et al, 2019).…”

“…In this paper, we draw on our experiences in two pilot projects that were undertaken to inform planning for scaling up the delivery of MNP in public health programmes in Ethiopia and Mozambique. Results of the evaluations are described in other papers in this supplement (G. H. Pelto et al, 2019;.…”