Abstract
BackgroundMicronutrient deficiencies affect many children in low-income settings due primarily to over-reliance on complementary foods low in nutrients. Home-fortification (HF) could improve children’s diet quality in these settings. The Ghana Health Service, supported by UNICEF, integrated the pilot Micronutrient Powder Initiative (MPI) into Child Welfare Clinic (CWC) services in four districts (Tain, Tolon, Talensi, and Ho West), whereby micronutrient powder (MNP) is supplied for HF for children aged 6–23 months attending CWCs. This study’s main aim was to identify the facilitators, barriers and “lessons learned” after 2 years of program implementation.MethodsThis was a qualitative cross-sectional study. MNP distributed and children enrolled were obtained from program records. Primary data were collected from November to December 2019 and included, by district: interviews with senior program staff; key informant interviews and focus group discussion with caregivers in each of 6 sub-districts; and discussions workshop with frontline staff from at least 10 health facilities. Besides field notes, all interactions were audio-recorded and transcribed verbatim. Qualitative data were analyzed using NVivo10.ResultsThe MPI remains on-going, with about 2.5 million MNP sachets distributed to nearly 30,000 children within 90 district-months. Caregivers generally accept the MNP; reported positive responses in children include: “increased appetite”, “less frequent illnesses, “increased energy/strength”, “increased weight”, and “walking independently relatively early”. Main facilitators are: generally regular MNP availability; increased patronage of CWC services; various contact points for supplying MNPs; fairly strong social mobilization strategy; good integration of MPI with CWC services; “one-on-one” counselling for caregivers reporting side effects; and tracing caregivers to address concerns and monitor adherence. Main barriers are: lack of counselling materials; caregivers’ suspicions towards the program; absence of refresher training for frontline workers; and perceived MNP side-effects. Key lessons learned are: incorporating MNPs into CWC services is feasible, acceptable, and could reduce child micronutrient deficiencies in program districts; and MPI’s success requires stronger community sensitization, equipping frontline workers to advise caregivers and manage side-effects, and consciously identifying and managing logistical challenges.ConclusionFurther research is needed to evaluate the effectiveness of the MPI in reducing micronutrient deficiencies among 6–23-months-olds in Ghana.
Highlights
Micronutrient deficiencies affect many children in low-income settings due primarily to over-reliance on complementary foods low in nutrients
Ho West received the highest amount of micronutrient powder (MNP), followed by Tain district, and Talensi district
With respect to the number of children enrolled into the Micronutrient Powder Initiative (MPI), Tain district had the highest number of children, followed by Tolon, while Ho West had the lowest number of children
Summary
Micronutrient deficiencies affect many children in low-income settings due primarily to over-reliance on complementary foods low in nutrients. Anemia and micronutrient deficiencies in children are major public health problems in many low-and middleincome countries [1]. One reason for the high prevalence of anemia and micronutrient deficiency in children in Ghana is the dependence on complementary foods based on cereal paps low in nutrients [5]. In such setting, home (point-of-use) fortification of complementary foods might be a pragmatic strategy for improving diet quality, and thereby treat and/or prevent anemia and micronutrient deficiencies in this vulnerable group. Home fortification has several advantages: it can be targeted to specific groups or households; be incorporated into the usual complementary diet without necessitating a major dietary modification [6]; and be used to deliver micronutrients to vulnerable groups in remote settings where fortified products are not affordable or available
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