Using Formative Research to Inform the Design of a Home Fortification with Micronutrient Powders (MNP) Program in Aileu District, Timor-Leste

Osei, Akoto; Septiari, Andi Mariyasari; Suryantan, Julia; Hossain, Md. Monjur; Chiwile, Faraja; Sari, Mayang; Pinto, Paulino; Soares, Dirce Maria; Faillace, Silvana

doi:10.1177/156482651403500109

Cited by 16 publications

(36 citation statements)

References 14 publications

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“…The barriers and facilitators to MNP use found in this study are consistent with those from previous studies conducted in Peru and globally Akoto Osei et al, 2014;Creed-Kanashiro et al, 2016;Sarma et al, 2016;Huamán-Espino et al, 2012;Jefferds et al, 2010;Munares-García & Gómez-Guizado, 2016;Kodish et al, 2011). Concerns for gastrointestinal side effects from MNP use have been widely discussed in the literature (Creed-Kanashiro et al, 2016;Jefferds et al, 2010;Kodish et al, 2011;Munares-García & Gómez-Guizado, 2016;Osei et al, 2014;Sarma et al, 2016), and other studies in Peru support the idea that poor taste can cause complications in MNP administration (Creed-Kanashiro et al, 2016;Huamán-Espino et al, 2012). However, other studies show that the extent to which side effects influence MNP adherence can vary based on the counselling provided and that caregivers are less likely to forego administration if they are warned about these issues (Pelletier & DePee, 2019;Tumilowicz, Schnefke, Neufeld, & Pelto, 2017).…”

Section: Discussionsupporting

confidence: 91%

Micronutrient powder use in Arequipa, Peru: Barriers and enablers across multiple levels

Brewer

Santos

Román

et al. 2019

Maternal & Child Nutrition

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In Peru, nearly half of children aged 6–36 months were diagnosed with anaemia in 2017. To address this disease, the Peruvian Ministry of Health implemented a national programme in 2014, distributing free micronutrient powders (MNPs) to all children of this age. However, rates of childhood anaemia remain high. The aim of this study was to explore factors at all levels of the Social‐Ecological Model that affect MNP use and adherence in Arequipa, an Andean city with childhood anaemia rates higher than the national average. We conducted in‐depth interviews with 20 health personnel and 24 caregivers and 12 focus group discussions with 105 caregivers. We identified numerous barriers, including negative side effects (constipation, vomiting, and diarrhoea), poor taste of MNP, lack of familial and peer support for its use, insufficient informational resources provided by the health system, and limited human resources that constricted health personnel abilities to implement MNP programming successfully. Facilitators identified included concern about the long‐term effects of anaemia, support from organizations external to the health system, well‐coordinated care within the health system, and provision of resources by the Ministry of Health. We found that community or organizational and societal factors were key to limited MNP use and adherence, specifically the limited time health personnel have to address caregivers' doubts during appointments and the lack of informational resources outside of these appointments. Potential policy implications could be to increase informational resources available outside of individualized counselling by strengthening existing collaborations with community organizations, increasing media coverage, and providing group counselling.

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Section: Discussionsupporting

confidence: 91%

Micronutrient powder use in Arequipa, Peru: Barriers and enablers across multiple levels

Brewer

Santos

Román

et al. 2019

Maternal & Child Nutrition

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“…It has been used successfully to explore acceptance and develop interventions for MNP in Timor‐Leste (Osei et al . ), Niger (Tripp et al . ), Kenya (Jefferds et al .…”

Section: Discussionmentioning

confidence: 99%

“…In-depth formative research including the methodology of household trials is necessary to inform and develop appropriate strategies to deliver interventions for a specific population (PAHO, UNICEF Pan-American Health Organization (PAHO) & UNICEF 2013) although it does not necessarily guarantee acceptance on a wider scale. It has been used successfully to explore acceptance and develop interventions for MNP in Timor-Leste (Osei et al 2014), Niger (Tripp et al 2011), Kenya (Jefferds et al 2010 and Mexico (Young et al 2010). In this study, we have used the methodology to explore issues arising in an ongoing programme.…”

Section: Discussionmentioning

confidence: 99%

Promoting multi‐micronutrient powders (MNP) in Peru: acceptance by caregivers and role of health personnel

Creed‐Kanashiro

Bartolini

Abad

et al. 2015

Maternal & Child Nutrition

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Iron deficiency causes anaemia and other adverse effects on the nutritional status and development of millions of children. Multi‐micronutrient powders (MNP) have been shown to reduce anaemia in young children. In Peru, 50% of children 6–36 months are anaemic. Since 2009, the government has started distributing MNP. This qualitative study explored the acceptability of MNP by caregivers and the role of health personnel (HP) in three regions (Apurimac, Ayacucho and Cajamarca), piloting the MNP programme between 2009 and 2011. Data collection consisted of interviews (35) and observations (13) with caregivers and HP (11). In Cajamarca, 16 families were visited three times in their homes to understand caregivers' use and difficulties. Results showed the critical role HP has in influencing caregiver understanding and use of the MNP, as well as the need for training to avoid confusing messages and provide counselling techniques that consider cultural sensitivity to optimize HP interactions with caregivers and adapt the recommendations for MNP use to local family feeding routines. There was greater acceptance of MNP by caregivers giving semi‐solid foods (e.g. purees) to their children than those who served dilute preparations (e.g. soups). Acceptance was similar across regions, but there were some differences between urban and rural settings. Home visits were shown to be a key in improving the use of MNP by caregivers as misunderstandings on preparation, required consistency and optimum practices were common. These findings can contribute to strategies to enhance acceptability and use.Key messages Acceptance and use of multi‐micronutrient powders (MNP) by caregivers greatly depend upon how it is presented, promoted and counselled by health personnel.Counselling for MNP use needs to consider and adapt to the local cultural context and incorporate family and child feeding routines.MNP are presented as part of appropriate feeding practices, encouraging caregivers to find simple and acceptable ways of giving semi‐solid or solid foods with which to mix it. © 2015 Blackwell Publishing Ltd

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“…El estudio también destaca que a nivel de sistema de salud, las motivaciones para el uso de MNP serían la retroalimentación del personal de salud sobre la evolución del niño, la orientación adecuada al contexto y el horario alternativo para recoger los MNP; estos hallazgos son similares a los de Creed et al quienes también reportan otros facilitadores como las visitas domiciliarias, sesiones demostrativas y mezclar el MNP con plátano (12) , nosotros no encontramos referencia de estas estrategias, las cuales mejoran la pertinencia cultural de esta intervención tan compleja (26) . Las madres resaltan las ventajas del MNP sobre el sulfato ferroso, como que el suplemento se puede esconder en los alimentos, se siente menos el sabor y no tiñe los dientes; no encontramos estudios que hayan explorado este aspecto.…”

Section: Discussionunclassified

Barreras y facilitadores a la suplementación con micronutrientes en polvo. Percepciones maternas y dinámica de los servicios de salud

Aparco

Huamán-Espino

2017

Rev Peru Med Exp Salud Publica

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Using Formative Research to Inform the Design of a Home Fortification with Micronutrient Powders (MNP) Program in Aileu District, Timor-Leste

Cited by 16 publications

References 14 publications

Micronutrient powder use in Arequipa, Peru: Barriers and enablers across multiple levels

Micronutrient powder use in Arequipa, Peru: Barriers and enablers across multiple levels

Promoting multi‐micronutrient powders (MNP) in Peru: acceptance by caregivers and role of health personnel

Barreras y facilitadores a la suplementación con micronutrientes en polvo. Percepciones maternas y dinámica de los servicios de salud

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