Locks Lindsey M, Dahal Pradiumna, Pokharel Rajkumar, Joshi Nira, Paudyal Naveen, Whitehead Ralph D, Chitekwe Stanley, Mei Zuguo, Lamichhane Bikash, Garg Aashima, Jefferds Maria Elena
Harvard TH Chan School of Public Health, Boston, MA.
UNICEF Headquarters, New York, NY.
Curr Dev Nutr. 2018 Apr 25;2(6):nzy019. doi: 10.1093/cdn/nzy019. eCollection 2018 Jun.
Three-quarters of the ≥50 programs that use micronutrient powders (MNPs) integrate MNPs into infant and young child feeding (IYCF) programs, with limited research on impacts on IYCF practices.
This study assessed changes in IYCF practices in 2 districts in Nepal that were part of a post-pilot scale-up of an integrated IYCF-MNP program.
This analysis used cross-sectional surveys ( = 2543 and 2578 for baseline and endline) representative of children aged 6-23 mo and their mothers in 2 districts where an IYCF program added MNP distributions through female community health volunteers (FCHVs) and health workers (HWs). Multivariable log-binomial models estimated prevalence ratios comparing reported IYCF at endline with baseline and at endline on the basis of exposure to different sources of IYCF information. Mothers who received FCHV-IYCF counseling with infrequent (≤1 time/mo) and frequent (>1 time/mo) interactions were compared with mothers who never received FCHV-IYCF counseling. The receipt of HW-IYCF counseling and receipt of MNPs from an FCHV (both yes or no) were also compared.
The prevalence of minimum dietary diversity (MDD) and minimum acceptable diet (MAD) was significantly higher at endline than at baseline. In analyses from endline, compared with mothers who never received FCHV counseling, only mothers in the frequent FCHV-IYCF counseling group were more likely to report feeding the minimum meal frequency (MMF) and MAD, with no difference for the infrequent FCHV-IYCF counseling group in these indicators. HW-IYCF counseling was not associated with these indicators. Mothers who received MNPs from their FCHV were more likely to report initiating solid foods at 6 mo and feeding the child the MDD, MMF, and MAD compared with mothers who did not, adjusting for HW- and FCHV-IYCF counseling and demographic covariates.
Incorporating MNPs into the Nepal IYCF program did not harm IYCF and may have contributed to improvements in select practices. Research that uses experimental designs should verify whether integrated IYCF-MNP programs can improve IYCF practices.
在使用微量营养素粉（MNP）的50多个项目中，四分之三将MNP纳入婴幼儿喂养（IYCF）项目，而对IYCF实践影响的研究有限。
本研究评估了尼泊尔两个地区IYCF实践的变化，这两个地区是IYCF - MNP综合项目试点后扩大规模的一部分。
本分析使用了横断面调查（基线和终线调查分别为2543人和2578人），这些调查代表了两个地区6至23个月大的儿童及其母亲，在这两个地区，IYCF项目通过女性社区卫生志愿者（FCHV）和卫生工作者（HW）增加了MNP的分发。多变量对数二项模型估计了患病率比，比较了终线时报告的IYCF与基线时以及基于接触不同IYCF信息来源的终线时的IYCF。将接受FCHV - IYCF咨询且互动不频繁（≤1次/月）和频繁（>1次/月）的母亲与从未接受FCHV - IYCF咨询的母亲进行比较。还比较了接受HW - IYCF咨询的情况以及从FCHV处获得MNP的情况（两者均为是或否）。
终线时的最低饮食多样性（MDD）和最低可接受饮食（MAD）患病率显著高于基线时。在终线分析中，与从未接受FCHV咨询的母亲相比，只有频繁接受FCHV - IYCF咨询组的母亲更有可能报告达到最低进餐频率（MMF）和MAD，在这些指标上不频繁接受FCHV - IYCF咨询组没有差异。HW - IYCF咨询与这些指标无关。与未从FCHV处获得MNP的母亲相比，从FCHV处获得MNP的母亲在调整了HW - 和FCHV - IYCF咨询及人口统计学协变量后，更有可能报告在6个月时开始添加固体食物并让孩子达到MDD、MMF和MAD。
将MNP纳入尼泊尔IYCF项目不会损害IYCF，并且可能有助于某些实践的改善。使用实验设计的研究应验证IYCF - MNP综合项目是否能改善IYCF实践。
