Infant and Young Child Feeding (IYCF) Practices Improved in 2 Districts in Nepal during the Scale-Up of an Integrated IYCF and Micronutrient Powder Program

Abstract

Background: Three-quarters of the ≥50 programs that use micronutrient powders (MNPs) integrate MNPs into infant and young child feeding (IYCF) programs, with limited research on impacts on IYCF practices.

Objective: This study assessed changes in IYCF practices in 2 districts in Nepal that were part of a post-pilot scale-up of an integrated IYCF-MNP program.

Methods: This analysis used cross-sectional surveys (n = 2543 and 2578 for baseline and endline) representative of children aged 6-23 mo and their mothers in 2 districts where an IYCF program added MNP distributions through female community health volunteers (FCHVs) and health workers (HWs). Multivariable log-binomial models estimated prevalence ratios comparing reported IYCF at endline with baseline and at endline on the basis of exposure to different sources of IYCF information. Mothers who received FCHV-IYCF counseling with infrequent (≤1 time/mo) and frequent (>1 time/mo) interactions were compared with mothers who never received FCHV-IYCF counseling. The receipt of HW-IYCF counseling and receipt of MNPs from an FCHV (both yes or no) were also compared.

Results: The prevalence of minimum dietary diversity (MDD) and minimum acceptable diet (MAD) was significantly higher at endline than at baseline. In analyses from endline, compared with mothers who never received FCHV counseling, only mothers in the frequent FCHV-IYCF counseling group were more likely to report feeding the minimum meal frequency (MMF) and MAD, with no difference for the infrequent FCHV-IYCF counseling group in these indicators. HW-IYCF counseling was not associated with these indicators. Mothers who received MNPs from their FCHV were more likely to report initiating solid foods at 6 mo and feeding the child the MDD, MMF, and MAD compared with mothers who did not, adjusting for HW- and FCHV-IYCF counseling and demographic covariates.

Conclusions: Incorporating MNPs into the Nepal IYCF program did not harm IYCF and may have contributed to improvements in select practices. Research that uses experimental designs should verify whether integrated IYCF-MNP programs can improve IYCF practices.

Keywords: complementary feeding; dietary diversity; home-based fortification; infant and young child feeding; micronutrient powders; point-of-use fortification.

FIGURE 1

Mechanisms through which CHW delivery of MNP can improve IYCF practices, which are used to guide variables in analytic models. CHW, community health worker; IYCF, infant and young child feeding; MNP, micronutrient powder.

FIGURE 2

Comparing maternal report of IYCF practices at endline on the basis of whether the mother received IYCF counseling from an FCHV, accounting for frequency of mother-FCHV interactions, and whether the FCHV provided MNPs to mothers of children aged 6–23 mo in Kapilvastu and Achham districts, Nepal. APRs and corresponding 95% CIs and P values were obtained from log-binomial regression models that accounted for correlated errors within clusters with the use of an exchangeable correlation structure. Models were adjusted for child's sex, caste, and age; maternal education; household food-insecurity score and household asset tertile; as well as household access to health services (time mother spends traveling to see her FCHV and to her nearest health center); maternal health-seeking behavior (whether she received home visits from her FCHV, sees an FCHV elsewhere, or both); and whether the mother ever received IYCF counseling from a health worker. In accordance with the UNICEF IYCF indicators, minimum dietary diversity is defined as feeding of ≥4 food groups (out of 7) in the previous 24 h. Minimum meal frequency is defined as ≥2 times/d for breastfed infants aged 6–8 mo, ≥3 times/d for breastfed children aged 9–23 mo, and ≥4 times/d for nonbreastfed children aged 6–23 mo. Minimum acceptable diet is defined as minimum meal frequency and minimum dietary diversity in the previous 24 h for breastfed children; for nonbreastfed children, minimum acceptable diet is defined as ≥2 milk feedings, the minimum meal frequency, and ≥4 food groups (from a total of 6 food groups that excludes dairy) in the previous day. APR, adjusted prevalence ratio; FCHV, female community health volunteer; Frequent FCHV-IYCF only, mothers who report receiving IYCF counseling from an FCHV and seeing the FCHV ≥2 times/mo but who report not receiving MNP from the FCHV; IYCF, infant and young child feeding; MNP, micronutrient powder; MNP only, mothers who received MNP from their FCHV but report either not receiving IYCF counseling from an FCHV or receiving FCHV-IYCF counseling with infrequent (once per month or less) interactions with their FCHV; MNP + frequent FCHV-IYCF, mothers who report receiving MNP from their FCHV and also report receiving IYCF counseling from the FCHV with frequent FCHV interactions (≥2 times/mo); No MNP + No/infrequent FCHV-IYCF, mothers who report they did not receive MNP from their FCHV and either never received IYCF counseling from an FCHV or received FCHV-IYCF counseling but with infrequent (once per month or less) interactions with their FCHV.