Determinants of Acceptability, Uptake, and Adherence to Micronutrient Powder Among Caregivers of Children Aged 6–23 Months in Kano Metropolis: A Concurrent Mixed-Methods Study

Abstract

Background
Childhood malnutrition remains a major public health challenge in Northern Nigeria, where micronutrient deficiencies are highly prevalent. The World Health Organisation recommends home fortification with micronutrient powder (MNP) to address these deficiencies, yet evidence on its real-world utilisation in Kano State is limited.

Objective
This study assessed the acceptability, uptake, and adherence to MNP among caregivers of children aged 6–23 months in Kano Metropolis and identified key predictors and barriers influencing use.

Methods
A concurrent mixed-methods cross-sectional design was employed among 375 caregivers, using interviewer-administered questionnaires and eight focus group discussions. Descriptive, bivariate, and multivariable logistic regression analyses were conducted, with statistical significance set at p < 0.05. Qualitative data were thematically analysed to explore facilitators and barriers.

Results
Nearly all caregivers (98.4%) reported having administered MNP at least once, demonstrating high acceptability. However, only 76.4% achieved daily uptake and 78.9% met adherence (≥80% sachets in 24 days). Acceptability was strongly associated with caregivers’ belief that MNP can prevent diseases (AOR = 3.58; 95% CI: 1.19–10.73; p = 0.001). Uptake was predicted by child tolerance (AOR = 7.21; 95% CI: 3.07–16.89; p < 0.001). Adherence was associated with caregiver employment (AOR = 2.03; 95% CI: 1.18–3.52; p = 0.011), presence of house help (AOR = 1.87; 95% CI: 1.07–3.26; p = 0.028), and child tolerance (AOR = 2.35; 95% CI: 1.15–4.80; p = 0.019). Perceived side effects, misinformation, and spousal opposition emerged as major barriers, while caregiver awareness, positive child response, and trust in health workers facilitated use.

Conclusion
Despite high acceptability, uptake and adherence remain suboptimal. Strengthening caregiver education, engaging male household members, and ensuring consistent MNP supply are critical for improving sustained utilisation in malnutrition-prone settings like Kano State.