Understanding acceptance, compliance, and utilization of Micronutrient Powder (MNP) in northern Nigeria – informing implementation through formative research
Authors: Kodish Stephen R. , Ejembi Clara Ladi , Osunkentan Tobi , Imohe Annette , Mathema Pragya 
Published: November 2023

ObjectiveDeveloping an at‐scale nutrition program that attempts to change nutrition‐related behaviors is challenging in northern Nigeria where hundreds of cultural groups and languages co‐exist within state borders. As part of the global Scaling Up Nutrition (SUN) movement, this study sought to describe household acceptance and utilization of MNP, as well as to understand the primary barriers and facilitating factors to its usage among children 6 – 23 months in Kebbi and Adamawa, Nigeria prior to program implementation.MethodsThis study of MNP utilization used multiple, mixed methods in a multi‐phase design as part of broader formative research efforts to design an infant and young child feeding (IYCF) program. Over two, four‐week phases, data were collected from 144 households participating in a home‐feeding trial with MNP. Households were purposively sampled to ensure an equal number of children (n = 48) enrolled into each age stratum (6 – 11 mo; 12 – 17 mo; 18 – 23 mo). In phase 1, we conducted full‐day (12‐hour) observations with a sub‐sample of households using MNP (n = 24). In phase 2, the same households (n = 18) were again observed to reduce reactivity. To triangulate observation findings, we conducted in‐depth interviews to understand individual experiences of male and female caregivers (n = 27) with MNP, as well as unannounced spot checks (n = 86) to gauge household compliance. Textual data from interviews and observation field notes were inductively analyzed using a team‐based coding approach with Dedoose software and drawing from Grounded Theory. Numerical data from observations and spot checks were analyzed using simple frequencies.ResultsOverall, the MNP was highly accepted: nearly 90.0% of caregivers indicated the MNP to be ‘easy’ or ‘very easy’ to use regularly. Spot check data illustrated that 76.7% (66/86) of households complied with instructions to use MNP regularly, with similar levels in Adamawa (34/44 = 77.3%) and Kebbi (32/42 = 76.2%) (see Figure 1). This finding was corroborated by direct observation data, which illustrated that 87.5% and 75.0% of households used MNP as instructed in Adamawa and Kebbi, respectively. Kunu and pap were the main food vehicles used by caregivers for fortifying MNP but observations revealed their varying levels of consistency depending on method of preparation. Six primary facilitating factors to MNP usage contributed to MNP utilization through caregiver perceptions of improved IYCF practices and better child health, creating a positive behavioral feedback loop (see Figure 2). 23.2% of households (20/86) had a ‘low’ compliance, with similar percentages between Adamawa (10/44 = 22.7%) and Kebbi (10/42 = 23.8%). Reported barriers to MNP utilization can be categorized as being product‐related (e.g., difficulty opening sachet), child‐related (e.g., did not finish fortified staple ), or caregiver‐related (e.g., difficulty making food daily).ConclusionsGlobal nutrition programs are increasingly introducing specialized nutritious foods to improve the nutritional status of vulnerable populations. This study presents positive findings of MNP acceptance and utilization in two different states of northern Nigeria. Developing specific program strategies to build off identified facilitating factors of MNP usage and help caregivers overcome the barriers revealed through the formative work will be essential for successful implementation and scale up both in this west African setting and others that are similar.Support or Funding InformationEuropean Union