An Investigation into the Differences in Coverage and Compliance of a Micronutrient Supplement Program for Children in Rupandehi and Palpa, Nepal

Abstract

Background: Malnutrition is a global problem, with its effects being more strongly accentuated in developing countries. In an effort to reduce the issue of child malnutrition in Nepal, UNICEF and Max Pro have devised a programme which provides children under the age of two year with a multiple micronutrient powder. This supplement has been a success; however, there are varying levels of coverage between districts. The aim of this project was to find reasons behind the differing coverage and compliance of children in two of Nepal’s districts. Methods: A qualitative study was carried out in two districts of Nepal. There were 18 participants in total: 12 mothers, 4 female community health volunteers and two health-in-charges. Each was interviewed, eliciting their understanding of the programme and its perceived strengths and weaknesses. Thoughts and experiences described in the responses were analyzed thematically. Results: There were varying levels of attendance of mothers at the teaching sessions conducted by FCHVs, and in some areas no teaching sessions were available. Many mothers had work commitments which they prioritized over the programme. Side effects of the supplement also deterred mothers from giving it to their children. FCHVs were also noted to be more inactive in certain villages. Their ability to convey information to mothers also varied between areas. Conclusions: The reason behind difference in coverage and compliance is a multi-factorial problem, predominantly affected by the actions of mothers and FCHVs. Distribution and geographical location of health facilities had less of an impact. Keywords: children; compliance; coverage; malnutrition; micronutrient.