The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6–23 Months in Madagascar

Abstract

This study assesses the impact of an integrated infant and young child feeding (IYCF) and micronutrient powder (MNP) intervention on children’s risk of anemia and IYCF practices in Madagascar. Quantitative baseline and endline surveys were conducted in representative households with children 6–23 months from two districts, where an 18-month IYCF-MNP intervention was implemented. Relative risks comparing children’s risk of anemia and maternal IYCF knowledge and practices at baseline versus endline, and also at endline among MNP-users versus non-users were estimated using log-binomial regression models. 372 and 475 children aged 6–23 months were assessed at baseline and endline respectively. Prevalence of anemia fell from 75.3% to 64.9% from baseline to endline (p = 0.002); the reduction in the risk of anemia remained significant in models adjusting for sociodemographic characteristics (ARR (95% CI): 0.86 (0.78, 0.95), p = 0.003). In endline assessments, 229 out of 474 (48.3%) of children had consumed MNPs. MNP-users had a lower risk of anemia (ARR (95% CI): 0.86 (0.74, 0.99), p = 0.04) than non-users, after controlling for child’s dietary diversity and morbidity, maternal counseling by community-health-workers, and sociodemographic characteristics. Mothers interviewed at endline also had greater nutrition knowledge and were more likely to feed their children ≥4 food groups (ARR (95% CI): 2.92 (2.24, 3.80), p < 0.001), and the minimum acceptable diet (ARR (95% CI): 2.88 (2.17, 3.82), p < 0.001) than mothers interviewed at baseline. Integration of MNP into IYCF interventions is a viable strategy for improving children’s consumption of micronutrients and reducing risk of anemia. The addition of MNP does not negatively impact, and may improve, IYCF practices.

Predictors of micronutrient powder sachet coverage and recent intake among children 12–23 months in Eastern Uganda

“…Differences in coverage by age in our analyses might be explained by caregiver perception of reduced risk of micronutrient malnutrition among older children and/or need for micronutrient supplementation in the Ugandan context. Our findings are contrary to studies where children 12–17 and 18–23 months had higher MNP consumption (Madagascar) and greater odds of obtaining MNP (Nepal) relative to children 6–11 months (Jefferds et al, ; Locks et al, ). However, our analyses did not include children 6–11 months, thus may not be comparable.…”

“…Similar to findings from MNP studies in Nepal and Madagascar (Mirkovic et al, ; Locks et al, ), children's perceptions of foods mixed with MNP were associated with coverage and recent intake. Children whose caregivers reported the child liked or was neutral about consuming foods mixed with MNP had nearly two‐times higher odds of recent intake relative to children whose caregivers reported the child disliked foods mixed with MNP.…”

Adherence and acceptability of community‐based distribution of micronutrient powders in Southern Mali

“…This allows for both growing familiarity with the intervention and continued improvements in nutritional status, building on the previous years' gains, to be assessed. Although disruption to MNP distribution in 2015 likely hindered this process, this is a problem commonly encountered by others too (Christofides, Schauer, Sharieff, & Zlotkin, ; Locks, Reerink, & Tucker Brown, ; Mirkovic et al, ). The primary limitation of our study is that although our results were consistent across the surveys and methods used, the data are largely based on parent reports of adherence and acceptability and could be subject to social desirability bias.…”

Predictors of micronutrient powder (MNP) knowledge, coverage, and consumption during the scale‐up of an integrated infant and young child feeding (IYCF‐MNP) programme in Nepal

“…FCHVs often interact with mothers more frequently and for longer durations than facility‐based health workers and are thus better positioned to deliver consistent IYCF‐MNP counselling and to help mothers troubleshoot as challenges arise. Other studies have also shown that community health workers are a viable and reliable channel for the delivery of MNP and IYCF‐MNP counselling (Locks et al, ; Olney et al, ). The reiteration of key messages through facility‐based health workers can complement community‐based counselling; however, our findings highlight that community health worker counselling may be especially important for supporting a deep understanding of how to use MNP and for supporting sustained use.…”

“…The frequency of maternal report of organoleptic changes may be a sign of inappropriate preparation of foods with MNP by mothers (such as adding MNP to hot foods, soups or other liquids, and/or very small portions of food; Tumilowicz et al, ); however, we did not find in this analysis that knowledge of appropriate use was associated with maternal report of organoleptic changes. Other MNP interventions have encountered product quality issues that resulted in organoleptic changes to food (Locks et al, ; Schauer et al, ). Taken together, these findings highlight the importance of not only ensuring a high quality MNP product (Schauer et al, ) but also incorporating behaviour change strategies that support mothers as they try different strategies to encourage the child to eat foods with MNP, such as mixing with highly flavourful foods such as bananas or curry, making sure the amount of food served to the child is sufficient to thoroughly mix in the MNP, or adding MNP to the child's food without their knowledge (Jefferds et al, ).…”