(PTFS18-03-26) Barriers and Facilitators to Supplement Uptake and Adherence Among Children 6-24 Months With Moderate Acute Malnutrition: Insights From the NUTRIMAM Trial

Objectives: Nutritional supplementation is pivotal to managing moderate acute malnutrition (MAM), yet uptake and adherence varies in practice. During the NUTRIMAM trial in Pakistan, variation in uptake was observed among children receiving one of three nutritional interventions: Ready-to-Use Supplementary food (RUSF), Micro-Biota-Directed Supplementary Food (MDSF), and Locally Available Foods (LAF). This study explored caregivers' perceptions and experiences to identify barriers and facilitators influencing supplement acceptance and adherence among children aged 6-24 months with MAM.

Methods: A descriptive exploratory qualitative study was conducted from April-May 2025 across three NUTRIMAM sites in Pakistan. Purposive sampling recruited caregivers of children with MAM receiving RUSF, MDSF, or LAF, including high and low adherence groups. Twenty-four in-depth interviews were conducted using a semi structured guide. Interviews were audio recorded, transcribed verbatim, translated into English, and analyzed using inductive thematic analysis.

Results: Four themes emerged: palatability and child acceptance; perceived health benefits; family support and socio-cultural influences; and maternal adaptability. Taste and texture facilitated uptake, while monotony and illness led to refusal. Perceived improvements in appetite and growth strengthened adherence, though side-effect concerns emerged. Household support and trust in the implementing institution supported use, while community skepticism and competing beliefs created challenges. Maternal resourcefulness and creative feeding strategies enabled continued supplement use despite practical constraints.

Conclusions: Supplement uptake and adherence was shaped by interacting behavioral and contextual barriers and facilitators beyond nutrient composition. Programs that prioritize palatability, strengthen caregiver counselling, and engage families and communities may improve adherence and effectiveness among children with MAM.

Funding Sources: World Health Organization (WHO) and Bill & Melinda Gates Foundation (BMGF)