Acceptability of multiple micronutrient powders and iron syrup in Bihar, India

Area of Science:

• Public Health Nutrition
• Maternal and Child Health
• Micronutrient Interventions

Background:

• Childhood anemia is highly prevalent in Bihar, India, affecting nearly two-thirds of young children.
• Iron and folic acid syrup (IFAS) and multiple micronutrient powders (MNPs) are established interventions for anemia prevention.
• Assessing the acceptability and preference of these interventions is crucial for effective implementation.

Purpose of the Study:

• To compare the acceptability and preference of pediatric iron and folic acid syrup (IFAS) versus multiple micronutrient powders (MNPs) in children aged 6-23 months.
• To evaluate adherence, perceived benefits, side effects, and ease of use for both IFAS and MNPs.
• To gather insights from mothers and frontline health workers on the practical aspects of administering these supplements.

Main Methods:

• A randomized crossover trial was conducted in Bihar, India, involving 100 children aged 6-23 months.
• Participants received either IFAS twice weekly or MNPs for one month, followed by the alternative intervention for another month.
• Data collection included household surveys, focus group discussions with health workers, and in-depth interviews with mothers.

Main Results:

• Both IFAS and MNPs demonstrated high adherence and acceptability, exceeding 80%.
• No significant differences were found in perceived benefits, side effects, or child/maternal preferences between IFAS and MNPs.
• Mothers and health workers noted that direct IFAS administration ensured full dosage, while MNP intake was dependent on food consumption.

Conclusions:

• Both IFAS and MNPs are highly acceptable and feasible interventions for preventing childhood anemia in Bihar.
• Direct administration of IFAS may ensure better compliance compared to MNPs, particularly for younger children.
• Integrating supplementation strategies with promotion of optimal child feeding practices is essential for maximizing the impact of micronutrient interventions.