Sustainability of market‐based community distribution of <scp>S</scp>prinkles in western <scp>K</scp>enya

Suchdev, Parminder S.; Shah, Ami B; Jefferds, Maria Elena; Eleveld, Alie; Patel, Minal; Stein, Aryeh D.; Macdonald, Barbara; Ruth, Laird J.

doi:10.1111/j.1740-8709.2012.00450.x

Cited by 23 publications

(38 citation statements)

References 20 publications

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“…After research support ended, continued monitoring activities relied on reporting systems maintained by the implementer, rather than household‐level data. These continued activities focused on the supply and distribution of MNP and promotional materials, as well as promotional activities undertaken by distributors (Suchdev et al, 2013). Sale of subsidized MNP at small stores/kiosks and pharmacies in Tanzania had effective internal monitoring systems for tracking supply and sales when the partners were involved.…”

Section: Resultsmentioning

confidence: 99%

“…The vast majority of published papers report on evaluations in the context of a pilot project (Creed‐Kanashiro, Bartolini, Abad, & Arevalo, 2015; Harris et al, 2012; Jefferds et al, 2015; Korenromp et al, 2015; Loechl et al, 2009; Mirkovic, Perrine, Subedi, Mebrahtu, Dahal, & Jefferds, 2016; Mirkovic, Perrine, Subedi, Mebrahtu, Dahal, Staatz, et al, 2015; Nguyen et al, 2016; Suchdev et al, 2010, 2013; Sun et al, 2011), with the exception of Bangladesh which reports on national programmes (Afsana, Haque, Sobhan, & Shahin, 2014; Angdembe, Choudhury, Haque, & Ahmed) and three large‐scale MNP distribution in refugee camps and in emergency contexts (de Pee et al, 2007; Kodish, Rah, Kraemer, de Pee, & Gittelsohn, 2011; Rah et al, 2012). …”

Section: Resultsmentioning

confidence: 99%

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Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Vossenaar¹,

Tumilowicz

D’Agostino

et al. 2017

Maternal & Child Nutrition

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“…These cards serve as reminders, visual cues and motivators to use MNP, and may help to establish regular intake routines, even if the boxes are not marked after use. Motivation and demand among participants are not static, especially for long-term interventions of several months or years that are at high risk of intervention fatigue; thus, 'refreshing' the promotion materials and messages and giving ongoing reminders of the benefits and to continue practising the intervention are needed (13,14) . The literature demonstrates that factors at multiple levels influence adherence (1) , but the cross-sectional design and content of the surveys limited our ability to explore many of these potentially critical issues.…”

Section: Discussionmentioning

confidence: 99%

Predictors of micronutrient powder intake adherence in a pilot programme in Nepal

Mirkovic¹,

Perrine²,

Subedi³

et al. 2015

Public Health Nutr.

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Objective: Poor adherence to recommended intake protocols is common and a top challenge for micronutrient powder (MNP) programmes globally. Identifying modifiable predictors of intake adherence could inform the design and implementation of MNP projects. Design: We assessed high MNP intake adherence among children who had received MNP ≥2 months ago and consumed ≥1 sachet (n 771). High MNP intake adherence was defined as maternal report of child intake ≥45 sachets. We used logistic regression to assess demographic, intervention components and perception-of-use factors associated with high MNP intake. Setting: Four districts of Nepal piloting an integrated infant and young child feeding and MNP project. Subjects: Children aged 6-23 months were eligible to receive sixty MNP sachets every 6 months with suggested intake of one sachet daily for 60 d. Cross-sectional surveys representative of children aged 6-23 months were conducted. Results: Receiving a reminder card was associated with increased odds for high intake (OR = 2·18, 95 % CI 1·14, 4·18); exposure to other programme components was not associated with high intake. Mothers perceiving ≥1 positive effects in their child after MNP use was also associated with high intake (OR = 6·55, 95 % CI 4·29, 10·01). Perceiving negative affects was not associated; however, the child not liking the food with MNP was associated with lower odds of high intake (OR = 0·12, 95 % CI 0·08, 0·20). Conclusions: Behaviour change intervention strategies tailored to address these modifiable predictors could potentially increase MNP intake adherence.

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“…This setting is characterized by endemic malaria transmission, high rates of diarrheal diseases because of poor access to safe water, and anemia (11). Details of the study methodology, including the promotion and monitoring of the interventions and effects on primary nutrition outcomes have been published elsewhere (10, 12, 13). Formative research on cultural conceptions of morbidity has also been previously reported (14).…”

Section: Methodsmentioning

confidence: 99%

Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in Western Kenya

Suchdev

Addo

Martorell

et al. 2016

The American Journal of Clinical Nutrition

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Background Although the use of micronutrient powders (MNPs) is considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials have challenged programmatic scale-up. Objective We aimed to measure the effects of community-based sales of MNPs on diarrhea-, fever-, cough-, and malaria-morbidity episodes in children 6–35 mo of age. Design We conducted a cluster-randomized trial in rural Western Kenya where 60 villages were randomly assigned to either intervention or control groups. MNPs (containing iron, vitamin A, zinc, and 11 other micronutrients) and other health products (e.g., insecticide-treated bednets, soap, and water disinfectant) were marketed in 30 intervention villages from June 2007 to March 2008. Household visits every 2 wk were used to monitor self-reported MNP use and morbidity (illness episodes in the previous 24 h and hospitalizations in the previous 2 wk) in both groups. Iron, vitamin A, anemia, malaria, and anthropometric measures were assessed at baseline and at 12 mo of follow-up. Data were analyzed by intent-to-treat analyses. Results Of 1062 children enrolled in the study, 1038 children (97.7%) were followed (a total of 14,204 surveillance visits). Mean MNP intake in intervention villages was 0.9 sachets/wk. Children in intervention villages, compared with children in control villages, had ~60% fewer hospitalizations for diarrhea (0.9% compared with 2.4%, respectively; P = 0.03) and 70% fewer hospitalizations for fever (1.8% compared with 5.3%, respectively; P = 0.003) but no significant differences in hospitalizations for respiratory illness (1.1% compared with 2.2%, respectively; P = 0.11) or malaria (3.1% compared with 2.9%, respectively; P = 0.82). There were no differences between groups in the numbers of episodes of diarrhea, cough, or fever. Conclusions MNP use in Western Kenya through market-based community sales was not associated with increased infectious morbidity in young children and was associated with decreased hospitalizations for diarrhea and fever. An integrated distribution of MNPs with other health interventions should be explored further in settings with a high child malnutrition and infection burden. This trial was registered at clinicaltrials.gov as NCT01088958.

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Sustainability of market‐based community distribution of Sprinkles in western Kenya

Cited by 23 publications

References 20 publications

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Experiences and lessons learned for programme improvement of micronutrient powders interventions

Predictors of micronutrient powder intake adherence in a pilot programme in Nepal

Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in Western Kenya

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