Home Fortification with Micronutrient Powders (MNP) for Improving Complementary Foods
In many parts of the world, local foods cannot provide all the nutrients a young child needs for growth and development. In particular, plant-based diets are typically low in absorbable forms of iron and vitamin A and are low in zinc. Vitamin and minerals are referred to as ‘micronutrients’ as they are very small molecules needed in the body in only tiny amounts. While small in size they are large in impact on health as they play a vital role in almost every aspect of human development and function. Dietary intake may meet energy needs, hence the feeling of hunger is not present, but may lack adequate vitamins and minerals. This is known as hidden hunger.
Providing caregivers regularly with small sachets of 15 micronutrients, including iron, allows them to ‘fortify’ whatever complementary foods they are providing their young children. Through this home based fortification, the prevalence of iron deficiency anaemia and the risks of other micronutrient deficiencies may be significantly reduced. These small sachets are known as Micronutrient Powders or MNP, and are relatively easy to use and an inexpensive way to provide vitamins and minerals that may be low in the local diet. MNP help to address one of the immediate causes of undernutrition, inadequate dietary intake. In spite of this, contextualization is essential if MNP are to be effective, as messages, delivery mechanisms, and training protocols all must be culturally adapted to each region. Particular consideration for current feeding practices and knowledge, as well as agricultural production and food availability and access is essential for programme design.
Our consulting team has provided technical support to governments and UN agencies at all stages of formative and operational research for home fortification programmes in multiple countries across Africa and Asia. Building on an understanding of local knowledge, attitudes, and practices around child feeding and care practices, culturally adapted programmes are designed and implemented. We have designed a multi-phase protocol for programme development, which progresses through formative research to community-based trials of improved practices, pilot studies, and scale-up activities.
PHASE 1
Formative research includes focus groups and key informant interviews of caregivers, health care providers and other stakeholders in regions within a country where agricultural and cultural practices may differ. Topics cover infant and child feeding and care practices, preferred communications methods, health and nutrition knowledge as well as general demographic information. Interviews are conducted in local languages with all questions, translated and transcribed for analysis by our team.
PHASE 2
Based on findings, communications and training materials are designed and tested in a community based trial, typically 30 days in length with 30-60 households. During the trial, utilization and adherence are closely monitored to assess how well the training messages are understood and get feedback from caregivers and the community on their perceptions of the product and its acceptability. Observational components are often included as well as initial cooking demonstrations using local foods.
Phases 3 & 4
Drawing on the results from the initial phases of work, the Nourish team advises on the design and implementation of all elements of pilot programs and national scale-ups, including communications, training, supply and distribution, and monitoring and evaluation. We conduct evaluations including responsive monitoring throughout programme implementation, revising protocols as needed to optimize coverage, utilization and adherence to protocols.
Training – Effective training of service providers is essential to the success of any health and nutrition programme. The Nourish team has extensive experience overseeing large-scale cascade trainings of health staff, including designing training plans, developing training manuals and materials, and facilitating master training sessions.
Communications – Our team has developed behaviour change communication strategies and materials to ensure effective communication and social mobilization for home fortification as a component of improving infant and young child feeding programmes in multiple countries. We have extensive experience designing country-specific artwork and messaging for print materials and media for programme promotion. We recognize that communication and social mobilization are critical elements of nutrition and health programmes, particularly communicating with families and communities to introduce and promote new interventions. To accomplish this, we aim to deliver culturally adapted materials that align with national identity and policy. For further details see Nutrition Education and Communication.
Supply and Distribution – Maximizing the effectiveness of interventions requires efficient supply chain management; stock-outs and bottlenecks can interrupt and limit the impact of otherwise effective programmes. Our team has provided support for the supply chain management, distribution of nutrition commodities as part of an integrated supply chain, end-user monitoring activities, bottleneck analyzes, as well as associated training and communication tools as part of large-scale pilots and national scale-ups. This included conducting a quantification of needs based on the target population, administration schedule, and duration of the intervention as well as creating and managing distribution plans.
Examples of our work
