A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda

Gaps in complementary feeding practices hinder the use of multiple micronutrients powder (MNP) in Rutsiro district in Rwanda. Successful MNP program implementation requires uninterrupted availability and accessibility to the product, as well as greater understanding of health benefits of the MNP. Key Findings In Rutsiro district, the unavailability of multiple micronutrients powder (MNP) was mentioned as a major barrier to accessing it. Factors that appeared to limit the use of MNP included perceived side effects and the perceptions that MNP is designed for undernourished children, coupled with inappropriate child feeding practices, particularly feeding thin/watery complementary foods. Mothers of older children (aged 12–23 months) had about 4 times higher odds of using MNP than mothers of younger children (aged 6–11 months), while mothers whose children participated in the supplementary food program had about 3 times higher odds of using MNP than mothers whose children have never participated in the program. Food insecurity, as indicated by increasing household hunger score, was significantly associated with reduced odds of using MNP. Key Implications MNP program implementers should: Ensure uninterrupted MNP supply and make MNP available to mothers while enhancing their understanding of the health benefits of MNP. Address gaps in complementary feeding practices by emphasizing timely introduction of diverse complementary foods of adequate consistency and supporting mothers' access to adequate complementary foods. ABSTRACT The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6–23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12–23 months) were more likely to use MNP than those of younger children (aged 6–11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.