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Abstract
Micronutrient deficiencies are mostly hidden; clinically less visible compared to macronutrient deficiencies. Food fortification with multiple micronutrients (MMN) is provided for children between 6–23 months, daily for two months at three-time points. We assessed the acceptance and adherence of this nutritional intervention in an urban community setting in Sri Lanka. This cross-sectional study enrolled caregivers of children aged 7 to 23 months with a cluster sampling method. Caregivers ’ acceptance of taste and smell, health gains, ease of use, and need perception (Cronbach’s reliability: 0.801) were assessed. Also, anemia knowledge (Cronbach’s reliability: 0.642), MMN knowledge, and reported adherence (number of sachets consumed per month) were evaluated through a self-administered questionnaire. Adequate adherence was defined as the use of ≥80% sachets. The univariate and multivariate statistical analysis examined the association of acceptability, adherence, and anemia knowledge with independent variables (socio-demographic, household characteristics, and knowledge). The survey included 153 respondents. The Median (range) age of children was 12 months (7–23). The mean (SD) acceptability score was 66.82% (9.78%). Acceptance of sensory qualities (smell/taste) had a lower score than perceived health benefit. Most consumed MMN adequately (72.5%). The mean (SD) anemia knowledge score was 62.20% (25.79%). In multivariate analysis, child’s age (OR: -0.360, 95% CI:-0.510,-0.211) and father’s education (OR: 2.148, 95% CI: 0.439, 3.857) were independently associated with acceptability. Child’s age (OR: -0.108, 95% CI:0.818, 0.985), anemia knowledge (OR:0.016, 95% CI: 1.003, 1.031) and acceptability (OR:0.236, 95% CI:1.140, 1.406) were significant determinants of adherence. Anemia knowledge was significantly associated with the mother’s education and household income when adjusted. In conclusion, unpleasant smell/taste and daily schedule were reported as barriers to MMN use. Yet, perception and trust regarding health benefits were encouraging. Reported adherence was somewhat high. Improving acceptability and anemia knowledge could enhance adherence further in this population.
Highlights
Micronutrient deficiencies are mostly hidden, and they are clinically less visible [1]
In response to high deficiency rates, the multiple micronutrients (MMN) supplementation program for 6–23-month-old children was first launched in Sri Lanka in 2007
We aimed to study the acceptance and adherence of the current schedule of MMN powder among children aged 7–23 months in an urban community setting in Sri Lanka
Summary
Micronutrient deficiencies are mostly hidden, and they are clinically less visible [1]. Vitamin A, iron, and zinc contribute significantly to morbidity and mortality in children under five years of age [2]. In low-income countries, the prevalence of iron deficiency in infants and toddlers ranges from 25–90% [3]. In Sri Lanka, it is about 26.5% [4]. Vitamin A deficiency is not uncommon, seen in 30% of children in Sri Lanka [4]. In response to high deficiency rates, the MMN supplementation program for 6–23-month-old children was first launched in Sri Lanka in 2007. The preparation contains 15 micronutrients, including iron (10mg), retinol, zinc, iodine, and vitamins (A, B1, B2, B3, B6, B12, C, D, E, and folic acid), copper, and selenium
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