Objectives
To identify factors of MNP acceptance and utilization and generate culturally-appropriate strategies for its introduction
Methods
This study used mixed methods in a multi-phase design. Phase 1 included interviews with community (n = 18) and religious leaders (n = 18), health workers (n = 30), and caregivers (n = 36). Phase 2 enrolled 144 households for an eight-week home-feeding trial with MNP. 12-hour observations (n = 24) were conducted to understand utilization. Participatory workshops (n = 24) and free lists (n = 81) were used to develop BCC. Phase 3 included repeated household observations (n = 18) and caregiver interviews (n = 28). Spot checks (n = 80) gauged MNP compliance.
Results
MNP was highly accepted: 90.0% of caregivers indicated MNP easy’ or very easy’ to use, with 76.7% (66/86) household compliance. Observations revealed 87.5% and 75.0% of households appropriately used MNP in Adamawa and Kebbi, respectively. Spot checks showed similarly high usage (Adamawa = 77.3%; Kebbi: 76.2%). Facilitating factors emerged as major themes, including 1) ease of use, 2) “no bitter flavor like medicine” 3) mixes readily with local foods, 4) ease of storage, 5) appropriate introduction by leaders & 6) husband support. Minimal barriers were reported. Community members recommended strategies of MNP introduction during workshops and salient young child food and illness terms were identified for behavioral messaging through free listing. Data suggest biomedical and local perceptions of nutrition do not align perfectly, with implications for programming identified.
Conclusions
MNP may be an appropriate intervention for this setting but tailored communications using formative findings from both biomedical and local communities are recommended to sustain acceptance and utilization.
