To explore causes of and potential solutions to poor acceptability of micronutrient powders (MNP) among caregivers as observed during a MNP pilot programme in Mbala district, Northern Province, Zambia, that included a nested effectiveness study.
Data are derived from multiple sources. Data analysis was performed at midline, six months after MNP was first distributed, based on external monitoring using focus group discussions and key informant interviews and routine monitoring reports. Six months later caregivers completed a questionnaire as part of endline data collection which included questions on acceptability of MNP and rumors.
Midline data revealed that aspects of the effectiveness study such as using length boards for anthropometry, drawing blood, signing consent forms, and using inclusion/exclusion criteria lead to rumors, which negatively impacted community and caregiver acceptability of MNP in the wider pilot programme. This necessitated changes to communication and mobilization strategies. At endline, 97% of caregivers reported that they would recommend the MNP to other caregivers, despite 57% of caregivers reporting that they had heard rumors and that 47% were discouraged from using Chipolopolo by others.
The inclusion of an effectiveness study, while valuable, introduced elements into the overall pilot programme that could have reduced acceptability of MNP among caregivers in the wider pilot. Monitoring and evaluation allowed for the identification of these issues and the modification of community mobilization strategies. This helped achieve an increase in acceptability by endline, despite the persistence of rumors. These findings highlight the importance of community mobilization and sensitization, as well as ongoing monitoring and evaluation.