title: Understanding low usage of micronutrient powder in the Kakuma Refugee Camp, Kenya: findings from a qualitative study.
abstract: BACKGROUND
  Home fortification with micronutrient powder has been shown to be a low-cost, feasible, and effective approach to address micronutrient deficiencies. A large-scale program distributing micronutrient powder to approximately 50,000 refugees was implemented at the Kakuma Refugee Camp in Kenya. Uptake of the micronutrient powder at distribution points dropped nearly 70%,from 99% to a low of 30%, and remained at 45% to 52% despite increased social marketing efforts.
  
  
  OBJECTIVE
  To identify factors at the distal and proximal levels leading to the low uptake of micronutrient powder through a qualitative inquiry.
  
  
  METHODS
  In-depth interviews were conducted with community leaders, stakeholders, implementing partners, and beneficiaries. Direct observations of food preparation and child feeding were conducted. Focus group discussions were employed to examine perceptions and practices of beneficiaries regarding micronutrient powder use.
  
  
  RESULTS
  Superficial formative research and lack of interagency coordination led to insufficient social marketing prior to the program. In addition, community health workers were inadequately trained. This resulted in inadequate communication regarding the health benefits and use of micronutrient powder to the beneficiaries. Reliance on personal experiences with micronutrient powder and issues with its packaging, in part, led to confusion and deleterious rumors, resulting in decreased uptake of micronutrient powder at distribution points.
  
  
  CONCLUSIONS
  A successful micronutrient powder program requires careful design, with emphasis on conducting thorough formative research, ensuring the involvement and commitment of all stakeholders from the outset, investigating the role of cultural factors, and ensuring provision of sufficient, adequate, and timely information to the beneficiaries.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kodish
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Rah
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraemer
authors.forename: Saskia
authors.initials: S
authors.lastname: de Pee
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
mesh_terms: D002675:Child, Preschool; D003142:Communication; D005247:Feeding Behavior; D005260:Female; D017144:Focus Groups; D018857:Food Packaging; D005522:Food Services / Q000458:organization & administration*; D005527:Food, Fortified / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D007630:Kenya / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000517:prevention & control*; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency; D009752:Nutritional Status; D015995:Prevalence; D036301:Qualitative Research; D012036:Refugees
chemical_list: D018977:Micronutrients