Supply‐ and Demand‐Side Factors Influencing Utilization of Infant and Young Child Feeding Counselling Services in Viet Nam

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 determinants of 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 the Alive & Thrive initiative, which embedded IYCF counseling in Viet Nam's health system. In addition, staff competence and performance during IYCF counseling, including technical and interpersonal communication skills, were observed and rated by trained enumerators.The percentages 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. Multinomial logistic regression showed that of three demand‐generation strategies (invitation cards, billboards, and TV spots), invitation cards were the strongest determinant of one‐time use (OR 5.2, 95% CI: 3.1–8.9), repeated use (OR 10.7, 95% CI: 6.7–17.1), and achievement of minimum visits (OR 12.4, 95% CI: 7.1–21.7). Higher maternal education, being a farmer, and belonging to an ethnic minority were associated with higher utilization, both for one‐time and repeated use. Having a wasted child was associated with greater odds of achieving the minimum recommended number of visits, whereas child stunting and illness were not. Living far from health center was associated with fewer repeated visits. Among supply‐side factors, good counselling skills (OR: 2–2.5) was the most important determinant of 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 22% of the population would have achieved the minimum number of visits if exposed to three demand‐generation strategies, and would further increase to 28% 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.Support or Funding InformationFunding support from Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360. Additional funding through the CGIAR Research Program on Agriculture for Nutrition and Health, hosted by IFPRI.