title: Promoting multi-micronutrient powders (MNP) in Peru: acceptance by caregivers and role of health personnel.
abstract: Iron deficiency causes anaemia and other adverse effects on the nutritional status and development of millions of children. Multi-micronutrient powders (MNP) have been shown to reduce anaemia in young children. In Peru, 50% of children 6-36 months are anaemic. Since 2009, the government has started distributing MNP. This qualitative study explored the acceptability of MNP by caregivers and the role of health personnel (HP) in three regions (Apurimac, Ayacucho and Cajamarca), piloting the MNP programme between 2009 and 2011. Data collection consisted of interviews (35) and observations (13) with caregivers and HP (11). In Cajamarca, 16 families were visited three times in their homes to understand caregivers' use and difficulties. Results showed the critical role HP has in influencing caregiver understanding and use of the MNP, as well as the need for training to avoid confusing messages and provide counselling techniques that consider cultural sensitivity to optimize HP interactions with caregivers and adapt the recommendations for MNP use to local family feeding routines. There was greater acceptance of MNP by caregivers giving semi-solid foods (e.g. purees) to their children than those who served dilute preparations (e.g. soups). Acceptance was similar across regions, but there were some differences between urban and rural settings. Home visits were shown to be a key in improving the use of MNP by caregivers as misunderstandings on preparation, required consistency and optimum practices were common. These findings can contribute to strategies to enhance acceptability and use.
  
  
  CONCLUSIONS
  Acceptance and use of multi-micronutrient powders (MNP) by caregivers greatly depend upon how it is presented, promoted and counselled by health personnel. Counselling for MNP use needs to consider and adapt to the local cultural context and incorporate family and child feeding routines. MNP are presented as part of appropriate feeding practices, encouraging caregivers to find simple and acceptable ways of giving semi-solid or solid foods with which to mix it.
authors.affiliation: Instituto de Investigación Nutricional, Lima, Peru.
authors.forename: Hilary
authors.initials: H
authors.lastname: Creed-Kanashiro
authors.affiliation: Instituto de Investigación Nutricional, Lima, Peru.
authors.forename: Rosario
authors.initials: R
authors.lastname: Bartolini
authors.affiliation: Instituto de Investigación Nutricional, Lima, Peru.
authors.forename: Melissa
authors.initials: M
authors.lastname: Abad
authors.affiliation: Instituto de Investigación Nutricional, Lima, Peru.
authors.forename: Varinia
authors.initials: V
authors.lastname: Arevalo
mesh_terms: D017028:Caregivers / Q000193:education; D002664:Child Nutritional Physiological Phenomena / Q000208:ethnology; D002675:Child, Preschool; D065246:Culturally Competent Care; D003677:Deficiency Diseases / Q000208:ethnology / Q000517:prevention & control*; D019587:Dietary Supplements; D063105:Food Assistance; D005518:Food Preferences / Q000208:ethnology; D005527:Food, Fortified; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006282:Health Personnel; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007225:Infant Food; D018977:Micronutrients / Q000008:administration & dosage / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010353:Patient Education as Topic; D010568:Peru / Q000453:epidemiology; D010865:Pilot Projects; D024382:Professional Role; D011368:Professional-Family Relations; D036301:Qualitative Research; D000078329:Workforce
chemical_list: D018977:Micronutrients
keywords: Peru; acceptability; anaemia; health personnel; infant and young child feeding; multi-micronutrient powders