Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
BMC Public Health. 2020 Jul 2;20(1):1046. doi: 10.1186/s12889-020-09103-8.
There is an increasing interest in use of food supplements to prevent childhood stunting, however the evidence on the process indicators is scarce. We in this study explore the barriers to the effective implementation of food supplementation programs and the possible mitigation strategies which can guide the design of future programs.
We undertook a process evaluation of a stunting prevention food supplementation pilot program in rural Pakistan that distributed Wheat Soy Blend (WSB) to pregnant & lactating women, and Lipid-based Nutrient Supplement (LNS) and micronutrient powder (MNP) to < 5 years children. We used a mixed methods approach through a quantitative survey of 800 households and conducted 18 focused group discussion (FGDs) (with male and female caregivers), 4 FGDs (with Community Health Workers (CHWs)) and 22 key informant interviews (with district stakeholders) to evaluate the community side factors affecting uptake through five parameters: value, acceptability, receipt of supplement, usage and correct dosage.
The findings show that proportionately few beneficiaries consumed the full dose of supplements, despite reasonable knowledge amongst caregivers. Sharing of supplements with other household member was common, and the full monthly stock was usually not received. Qualitative findings suggest that caregivers did not associate food supplements with stunting prevention. WSB was well accepted as an extra ration, LNS was popular due its chocolaty taste and texture, whereas MNP sprinkles were perceived to be of little value. The cultural food practices led to common sharing, whereas interaction with CHWs was minimal for nutrition counselling. Qualitative findings also indicate CHWs related programmatic constraints of low motivation, multi-tasking, inadequate counselling skills and weak supervision.
We conclude that the community acceptability of food supplements does not translate into optimal consumption. Hence a greater emphasis is needed on context specific demand creation and focusing on the supply side constraints with improved logistical planning, enhanced motivation and supervision of community workers with involvement of multiple stakeholders. While, similar studies are needed in varying contexts to help frame universal guidelines.
ClinicalTrials.gov Identifier: NCT02422953 . Registered on April 22, 2015.
人们对使用食品补充剂来预防儿童发育迟缓越来越感兴趣，但关于过程指标的证据却很少。本研究旨在探讨有效实施食品补充计划的障碍以及可能的缓解策略，为未来计划的设计提供指导。
我们对巴基斯坦农村地区一项预防发育迟缓的食品补充试点计划进行了过程评估，该计划向孕妇和哺乳期妇女发放了小麦大豆混合物（WSB），向<5 岁儿童发放了脂基营养素补充剂（LNS）和微量营养素粉（MNP）。我们采用混合方法，通过对 800 户家庭进行定量调查，并进行了 18 次焦点小组讨论（有男性和女性照顾者参加）、4 次焦点小组讨论（有社区卫生工作者参加）和 22 次关键知情人访谈（有地区利益相关者参加），评估了影响补充剂摄取的社区因素，涉及五个方面：价值、可接受性、补充剂的获取、使用和正确剂量。
调查结果显示，尽管照顾者有一定的相关知识，但只有少数受益者能够按剂量服用完整的补充剂。与其他家庭成员共享补充剂的情况很常见，而且通常无法收到整月的库存。定性研究结果表明，照顾者并未将食品补充剂与预防发育迟缓联系起来。WSB 作为额外的配给量被广泛接受，LNS 因其巧克力般的口感和质地而广受欢迎，而 MNP 撒粉则被认为价值不大。文化饮食习惯导致了常见的共享行为，而与社区卫生工作者的互动则很少进行营养咨询。定性研究结果还表明，社区卫生工作者存在动机不足、多任务处理、咨询技能不足和监督不力等项目限制因素。
我们得出结论，食品补充剂在社区的可接受性并不一定转化为最佳的消费。因此，需要更加注重特定背景下的需求创造，并重点解决供应方面的制约因素，包括改善后勤规划、增强社区工作者的积极性和监督、提高他们的咨询技能，并让多个利益相关者参与其中。同时，需要在不同的背景下进行类似的研究，以帮助制定普遍适用的指南。
ClinicalTrials.gov 标识符：NCT02422953。于 2015 年 4 月 22 日注册。
