Samuel Aregash, Brouwer Inge D, Pamungkas Nindya P, Terra Tosca, Lelisa Azeb, Kebede Amha, Osendarp Saskia J M
Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
Matern Child Nutr. 2021 Apr;17(2):e13111. doi: 10.1111/mcn.13111. Epub 2020 Nov 9.
In Ethiopia, home fortification of complementary foods with micronutrient powders (MNPs) was introduced in 2015 as a new approach to improve micronutrient intakes. The objective of this study was to assess factors associated with intake adherence and drivers for correct MNP use over time to inform scale-up of MNP interventions. Mixed methods including questionnaires, interviews and focus group discussions were used. Participants, 1,185 children (6-11 months), received bimonthly 30 MNP sachets for 8 months, with instruction to consume 15 sachets/month, that is, a sachet every other day and maximum of one sachet per day. Adherence to distribution (if child receives ≥14 sachets/month) and adherence to instruction (if child receives exactly 15[±1] sachets/month) were assessed monthly by counting used sachets. Factors associated with adherence were examined using generalized estimating equations. Adherence fluctuated over time, an average of 58% adherence to distribution and 28% for adherence to instruction. Average MNP consumption was 79% out of the total sachets provided. Factors positively associated with adherence included ease of use (instruction), child liking MNP and support from community (distribution and instruction) and mother's age >25 years (distribution). Distance to health post, knowledge of correct use (OR = 0.74, 95% CI = 0.66-0.81), perceived negative effects (OR = 0.73, 95% CI = 0.54-0.99) and living in Southern Nations, Nationalities and People Region (OR = 0.59, 95% CI = 0.52-0.67) were inversely associated with adherence to distribution. Free MNP provision, trust in the government and field staff played a role in successful implementation. MNP is promising to be scaled-up, by taking into account factors that positively and negatively determine adherence.
在埃塞俄比亚，2015年引入了用微量营养素粉（MNPs）对辅食进行家庭强化的方法，作为改善微量营养素摄入的新途径。本研究的目的是评估与摄入依从性相关的因素以及随着时间推移正确使用MNPs的驱动因素，为扩大MNPs干预措施提供依据。采用了包括问卷调查、访谈和焦点小组讨论在内的混合方法。1185名6至11个月大的儿童参与者，连续8个月每月收到两期共30包MNPs，并得到指示每月食用15包，即每隔一天食用一包，每天最多一包。通过清点已使用的包装每月评估分发依从性（如果儿童每月收到≥14包）和指示依从性（如果儿童每月恰好收到15[±1]包）。使用广义估计方程检查与依从性相关的因素。依从性随时间波动，分发依从性平均为58%，指示依从性为28%。MNPs的平均消费量占提供的总包装数的79%。与依从性呈正相关的因素包括使用方便（指示方面）、儿童喜欢MNPs以及社区支持（分发和指示方面）和母亲年龄>25岁（分发方面）。到卫生站的距离、正确使用知识（OR = 0.74，95%CI = 0.66 - 0.81）、感知到的负面影响（OR = 0.73，95%CI = 0.54 - 0.99）以及居住在南方各族裔人民地区（OR = 0.59，95%CI = 0.52 - 0.67）与分发依从性呈负相关。免费提供MNPs、对政府和实地工作人员的信任在成功实施中发挥了作用。考虑到对依从性有正面和负面影响的因素，MNPs有望扩大使用范围。
