A Delivery Model for Home Fortification of Complementary Foods with Micronutrient Powders: Innovation in the Context of Vietnamese Health System Strengthening.

Marie Nguyen,Alia Poonawala,Dominic Schofield,Magali Leyvraz,Tran Nga,Jacques Berger,Tran Van,Do Hoa,Frank Wieringa

doi:10.3390/nu8050259

Abstract

Adding micronutrient powders (MNP) to complementary foods at the point of preparation (home fortification) can improve micronutrient status of young children. Ensuring sustained access to MNPs at scale, however, remains challenging in many countries. The Global Alliance for Improved Nutrition (GAIN) partnered with the National Institute of Nutrition (NIN) in Vietnam to pioneer the distribution of a locally-produced MNP, provided for sale through the public health system with counseling on optimal infant and young child feeding practices by trained health workers. Different packaging options were available to adapt to caregivers’ disposable income. During the six-month pilot, 1.5 million sachets were sold through 337 health centers across four provinces, targeting children 6–59 months of age. Sales were routinely monitored, and a cross-sectional survey in 32 communes for caregivers (n = 962) and health staff (n = 120) assessed MNP coverage and compliance, five months after the start of distribution. A total of 404 caregivers among the 962 caregivers surveyed (i.e., 42%) had visited the health center in the past year. Among them, 290 caregivers had heard about the product and a total of 217caregivers had given the MNP to their child at least once, representing a conversion rate from product awareness to product trial of 74.8%. The effective coverage (i.e., consumption of ≥3 sachets/child/week) was 11.5% among the total surveyed caregivers and reached 27.3% amongst caregivers who visited health centers in the previous month. The MNP purchase trends showed that the number of sachets bought by caregivers was positively correlated with the wealth index. The pilot showed that providing MNPs for sale in packs of various quantities, combined with infant and young child feeding (IYCF) counseling at the health center, is effective for groups accessing the health system.

Highlights

micronutrient powders (MNP) were delivered for sale by health center staff for approximately six months to a total of 337 health centers, including four provincial health centers, 20 district health centers, and 313 commune health centers (CHCs)
In Hai Phong, 7 district health centers and 128 CHCs participated in the pilot; in Thai Nguyen, three district health centers and 37 CHCs participated; in Quang Nam, six district health centers and 94 CHCs participated; and in Ca Mau, four district health centers and
MNP sales in the four provinces during the project timeline varied by province, with a total of 1,000,500 sachets sold through the pilot and an additional 497,940 sachets sold to other national nutrition programs during the pilot intervention

Summary

Introduction

Nutrients 2016, 8, 259 rates have fallen from 58% in the early 1990s [1] to 11% in 2012 [2]. In parallel with socioeconomic development, the population of Vietnam has seen significant improvements in nutritional status, especially among children under five years of age. Malnutrition rates have fallen considerably, with a decrease in the prevalence of underweight from 45% in 1990 to 27% in 2004 [3] and a halving of the prevalence of stunting in only 20 years (from 60% in 1985 to 30% in 2005 [4]). Nutrient intakes have increased significantly [5], and anemia prevalence decreased from 45.5% in 1995 [6] to

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Conclusion