title: Factors Influencing Child Feeding Practices Related to Home Fortification With Micronutrient Powder Among Caregivers of Under-5 Children in Bangladesh.
abstract: BACKGROUND
  Anemia is a major public health concern in Bangladesh, affecting about 51% of under-5 children. There are a number of strategies to overcome this micronutrient-deficiency burden, and home fortification (HF) with micronutrient powder (MNP) is one of them.
  
  
  OBJECTIVE
  As part of an evaluation of an HF with MNP intervention program, we conducted a qualitative study to understand the factors influencing demand, purchase, and utilization of MNP by caregivers of under-5 children.
  
  
  METHODS
  We purposively selected study participants from 5 subdistricts and 1 urban slum in Bangladesh where HF with Pushtikona (a brand name of MNP) program is available. Data were collected through household observations and conducting in-depth interviews and focus group discussions with caregivers, grandmothers, and fathers of under-5 children.
  
  
  RESULTS
  Our study showed that caregivers were initially cautious, using Pushtikona on a trial basis, and afterward they employed various strategies to get their children to eat food fortified with Pushtikona. Barriers to acceptance and use of Pushtikona included inappropriate initiation of complementary feeding, discouragement from influential family members as well as miscommunication, conflicting information, and irregular visits by the health workers who sell Pushtikona to caregivers. Based on these findings, we characterized the users of Pushtikona as regular, ever, irregular, and never.
  
  
  CONCLUSIONS
  The evidence suggests that focusing on counseling caregivers and other family members on the importance of MNP and on age-appropriate feeding practices will be critical to the success of this intervention program as will regular visits by health workers and improved service delivery.
authors.affiliation: 1 Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh.
authors.forename: Haribondhu
authors.initials: H
authors.lastname: Sarma
authors.affiliation: 1 Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh.
authors.forename: Md Fakhar
authors.initials: MF
authors.lastname: Uddin
authors.affiliation: 2 The Children's Investment Fund Foundation (CIFF), United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Harbour
authors.affiliation: 1 Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
keywords: Bangladesh; anemia; home fortification; micronutrient powder