Abstract
Home fortification with micronutrient powders (MNP) has been shown to reduce anaemia, with high overall acceptability and adherence, but there is limited evidence from West Africa. Around 80% of children younger than 5 years are anaemic in Mali, and new interventions are needed. This paper reports on the adherence and acceptability of a community‐led MNP intervention targeting children aged 6–59 months in Southern Mali. The MNP were delivered by a multidisciplinary group of community volunteers using community‐based preschools, cooking demonstrations, and traditional communication networks to promote MNP, nutrition, hygiene, and child stimulation. The MNP were delivered alongside early childhood development interventions and seasonal malaria chemoprevention. Adherence and acceptability were evaluated through two cross‐sectional surveys in 2014 and 2016 and a qualitative evaluation in 2015. Over 80% of parents reported ever having given MNP to their child, with 65% having given MNP for four or more days in the last week. Likely contributors to uptake include: perceived positive changes in the children following MNP use, the selection of a food vehicle that was already commonly given to children (morning porridge or bouillie) and the community driven, decentralized and integrated delivery approach. These findings support recommendations from recent reviews of MNP implementation to use community‐based delivery approaches and behaviour change components.
Highlights
Between 40% and 50% of children younger than 5 years in developing countries are iron deficient (UNICEF, 2003)
In 2013, a cluster‐randomised trial was launched in 60 rural villages in Sikasso and Yorosso districts in Southern Mali to evaluate the impact of home fortification with micronutrient powders (MNP), combined with seasonal malaria chemoprevention (SMC; World Health Organization (WHO), 2012) and early childhood development (ECD) interventions, on children's health, nutritional status, and development
Interventions that improve iron status can increase the incidence of infectious diseases, including malaria (Prentice et al, 2017), and MNP are not recommended in sub‐Saharan Africa except where malaria is well controlled (WHO, 2011)
Summary
Between 40% and 50% of children younger than 5 years in developing countries are iron deficient (UNICEF, 2003). In 2011, the World Health Organization (WHO) recommended home fortification of foods with micronutrient powders (MNP) to improve iron status and reduce anaemia among infants and children aged 6–23 months, where the prevalence of anaemia in children is 20% or higher (World Health Organization [WHO], 2011). There is limited evidence on MNP adherence and impact from West Africa and none from Mali, where 80% of children younger than 5 years are anaemic (European Commission, 2017). In 2013, a cluster‐randomised trial was launched in 60 rural villages in Sikasso and Yorosso districts in Southern Mali to evaluate the impact of home fortification with MNP, combined with seasonal malaria chemoprevention (SMC; WHO, 2012) and early childhood development (ECD) interventions, on children's health, nutritional status, and development. This paper summarises findings relating to implementation of the MNP intervention, MNP adherence, and acceptability, assessed through a series of qualitative studies and quantitative surveys conducted during the trial period 2013–2016
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