Jefferds Maria Elena D, Mirkovic Kelsey R, Subedi Giri Raj, Mebrahtu Saba, Dahal Pradiumna, Perrine Cria G
Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.
Matern Child Nutr. 2015 Dec;11 Suppl 4(Suppl 4):77-89. doi: 10.1111/mcn.12214.
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.
许多国家实施微量营养素粉（MNP）计划以改善幼儿的营养状况。对于不同配送模式下MNP覆盖范围的预测因素，人们了解甚少。我们描述了尼泊尔农村地区针对6至23个月儿童的婴幼儿喂养和MNP干预措施中的MNP覆盖情况，比较了两种试行的配送模式：由女性社区卫生志愿者（FCHV）或在卫生设施（HF）分发MNP。在开始分发MNP后，对四个试点地区6至23个月儿童的母亲进行了横断面家庭整群调查。每个整群中的FCHV也接受了调查。我们使用逻辑回归来描述项目启动后3个月时初始覆盖（获得一批60袋MNP）和15个月时重复覆盖（符合条件的儿童中覆盖≥2次）的预测因素。在15个月时，FCHV模式下的初始和重复覆盖率更高，尽管在3个月时未观察到差异。参加由FCHV主导的讨论MNP的母亲小组会议，会增加两种模式在3个月时任何覆盖情况以及HF模式在15个月时重复覆盖的几率。认为孩子有≥1个积极效果会增加两种配送模式下重复覆盖的几率。与HF模式相比，FCHV模式中有更大比例的FCHV志愿者报告在3个月和15个月时负担增加（无统计学意义）。设计既能最大限度提高覆盖率又不会使系统负担过重的MNP计划可能具有挑战性，可能需要不止一种配送模式。
