Implementation of the multiple micronutrient supplementation programme among infants and young children in 13 districts in Sri Lanka: a mixed method study method study

Introduction: Micronutrient deficiency has remained a problem among infants and young children in Sri Lanka despite providing multiple micronutrients (MMN) for children less than 2 years in selected districts in the country. Program implementation had not been studied since its inception. Objectives: To assess the implementation of the MMN supplementation programme among infants and young children in thirteen districts in Sri Lanka. Methods: A mixed method study comprising a community based, cross-sectional descriptive component and a semi-structured qualitative component was conducted. We recruited 2520 children aged 7-21 months in three groups categorised according to the age of the child. Mothers of children responded to the interviewer-administered questionnaire which covered aspects of intervention fidelity, quality, participant responsiveness and dosage of the intervention. Public health midwives working in intervention districts responded to a semi-structured questionnaire on facilitators and barriers they encounter when they implement the program at the community level. Results: Overall response rate was 97.3% (n=2452). MMN sachets were received by 920 (37.8%) children during the last two months but only 27.3% (n=665) consumed them daily. Adherence to practices for providing MMN to children by mothers was more than 90%. Mothers had a satisfactory response to all knowledge variables (n=455; 68.4%). More than 80% of the children received a public health midwife home visit in parallel to MMN supplementation (80.3%) and 79.7% (n=817) mothers who received the supplementation were satisfied with the intervention. The main barrier encountered by midwives was unavailability of stocks. They also perceived side effects to be common and thought mothers never realized the importance of supplementing micronutrients. Conclusions: Issues in the distribution of MMN sachets resulted in poor coverage of the intervention at the community level.