Mixed methods evaluation explains bypassing of vouchers in micronutrient powder trial in Mozambique

Micronutrient powders (MNP) are recommended by the World Health Organization as an effective intervention to address anaemia in children. A formative process evaluation was conducted to assess the viability of a model using free vouchers in two districts of Mozambique to deliver MNP and motivate adherence to recommendations regarding its use. The evaluation consisted of (a) an examination of programme outcomes using a cross-sectional survey among caregivers of children 6-23 months (n = 1,028) and (b) an ethnographic study to investigate delivery experiences and MNP use from caregiver perspectives (n = 59), programme managers (n = 17), and programme implementers (n = 168). Using a mixed methods approach allowed exploration of unexpected programme outcomes and triangulation of findings. The survey revealed that receiving a voucher was the main implementation bottleneck. Although few caregivers received vouchers (11.5%, CI [9.7, 13.6]), one-fourth received MNP by bypassing the voucher system (26.3%, CI [23.6, 29.0]). Caregivers' narratives indicated that caregivers were motivated to redeem vouchers but encountered obstacles, including not knowing where or how to redeem them or finding MNP were not available at the shop. Observing these challenges, many programme implementers redeemed vouchers and distributed MNP to caregivers. Virtually, all caregivers who received MNP reported ever feeding it to their child. This study's findings are consistent with other studies across a range of contexts suggesting that although programmes are generally effective in motivating initial use, more attention is required to improve access to MNP and support continued use

Environmental health · Formative assessment · Medical education · Micronutrient · Pedagogy · Psychological intervention · Voucher · Child Nutrition and Water Access · Global Maternal and Child Health · Medicine · Nursing · Poverty, Education, and Child Welfare · Psychology · Accounting

• Factors associated with nutrition intervention adherence

  Open Access•Kim Siegal, Kelvin Musau et al.•Maternal and Child Nutrition•2022

  Incluir item

• Anthropological Research

  Open Access•Pertti J Pelto, G H Pelto•Anthropological Research•1978

  Incluir item

• Experiences and lessons learned for delivery of micronutrient powders interventions

  Open Access•Ietje Reerink, Sorrel ML Namaste et al.•Maternal and Child Nutrition•2017

  Incluir item

• Experiences and lessons learned for programme improvement of micronutrient powders interventions

  Open Access•Marieke Vossenaar, Alison Tumilowicz et al.•Maternal and Child Nutrition•2017

  Incluir item

• The focused ethnographic study ‘assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old’ and its use in three countries

  Open Access•G H Pelto, Margaret Armar‐Klemesu et al.•Maternal and Child Nutrition•2012

  Incluir item

• Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia

  Open Access•Alison Tumilowicz, Jean‐pierre Habicht et al.•Maternal and Child Nutrition•2019

  Incluir item

• Using ethnography in implementation research to improve nutrition interventions in populations

  Open Access•Alison Tumilowicz, Lynnette M Neufeld et al.•Maternal and Child Nutrition•2015

  Incluir item

• Focused ethnographic studies in the WHO programme for the control of acute respiratory infections

  Sandy Cove, Gove et al.•Medical Anthropology•1993

  Incluir item