Abstract
Adequate utilization of services is critical to maximize the impact of counselling on infant and young child feeding (IYCF), but little is known about factors affecting utilization. Our study examined supply- and demand-side factors associated with the utilization of IYCF counselling services in Viet Nam. We used survey data from mothers with children <2y (n = 1,008) and health staff (n = 60) from the evaluation of a program that embedded IYCF counseling into the existing government health system. The frequency of never users, one-time users, repeat users, and achievers of the recommended minimum number of visits at health facilities were 45.1%, 13.0%, 28.4% and 13.5%, respectively. Poisson regression showed that demand-generation strategies, especially invitation cards, were the key factors determining one-time use (Prevalence ratio, PR 3.0, 95% CI: 2.2–4.2), repeated use (PR 3.2, 95% CI: 2.4–4.2), and achievement of minimum visits (PR 5.5, 95% CI: 3.6–8.4). Higher maternal education was associated with higher utilization both for one-time and repeated use. Being a farmer, belonging to an ethnic minority, and having a wasted child were associated with greater likelihood of achieving the minimum recommended number of visits, whereas child stunting or illness were not. Distance to health center was a barrier to repeated visits. Among supply-side factors, good counselling skills (PR: 1.3–1.8) was the most important factor associated with any service use, whereas longer employment duration and greater work pressure of health center staff were associated with lower utilization. Population attributable risk estimations showed that an additional 25% of the population would have achieved the minimum number of visits if exposed to three demand-generation strategies, and further increased to 49% if the health staff had good counseling skills and low work pressure. Our study provides evidence that demand-generation strategies are essential to increase utilization of facility-based IYCF counselling services in Viet Nam, and may be relevant for increasing and sustaining use of nutrition services in similar contexts.
Highlights
Best practices in infant and young child (IYCF) feeding are essential for improving the nutritional status of children and promoting healthy growth and development [1,2,3]
Data used for this study were from household and health staff surveys which were conducted in the context of a cluster-randomized impact evaluation to compare the impact of two Alive & Thrive (A&T) intervention packages in Vietnam, i.e., an intensive package consisting of intensified interpersonal counseling and mass media compared to a non-intensive package consisting of standard nutrition counseling along with mass media [22]
Three-fourths of the families lived within ten minutes of a MTBT center
Summary
Best practices in infant and young child (IYCF) feeding are essential for improving the nutritional status of children and promoting healthy growth and development [1,2,3]. Both breastfeeding and complementary feeding practices remain suboptimal in developing countries, where the prevalence of exclusive breastfeeding is about 39% [4]. High-quality and timely IYCF counselling has been shown to be an effective strategy to improve both child feeding practices and the nutritional status of children [6,7,8]. The delivery of clear educational messages on complementary feeding practices which emphasize the importance of hygienic, high-energy and appropriate home-prepared foods, coupled with the timely introduction of complementary foods, has been shown to lead to significant gains in the height and weight of children in low and middle-income countries [11]
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