Abstract
Background
Childhood malnutrition is a major global public health issue, especially in low- and middle-income countries. In Nepal, Fortified Blended Flour (FBF) is distributed through the Mother and Child Health and Nutrition Program, targeting the most food-insecure districts. Evaluating coverage, utilization, and barriers is crucial. This study investigated these aspects and factors influencing the regular use of FBF among children aged 6–23 months in Karnali Province.
Methods
A community-based cross-sectional study was conducted among 423 mothers of children aged 6–23 months in Khadachakra Municipality, Kalikot district. The probability proportionate to size method selected participants from each ward. Face-to-face interviews were conducted via a pretested semi-structured questionnaire. Coverage and utilization of FBF and reasons for irregular use are presented as frequency distributions. Chi-square tests, binary logistic regression, and multiple logistic regression examined associations. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) demonstrated the association between independent variables and regular use of FBF.
Results
All respondents were aware of the FBF distribution program (message coverage 100%), and 96.9% reported ever receiving FBF (contact coverage). Among those reporting contact coverage (N = 410), 48% utilized FBF regularly. Key reasons for regular utilization were perceived benefits for child growth (37.6%), free distribution (27.7%), and health worker recommendations (23.9%). Main reasons for irregular utilization included intrahousehold sharing (24.3%), stock shortages (14.2%), and lack of communication with distributors (13.7%). Factors associated with regular utilization included intrahousehold sharing (AOR: 4.22, 95% CI: 2.16–8.24), accepted taste of FBF (AOR: 2.44, 95% CI: 1.24–4.79), mothers as decision-makers (AOR: 2.67, 95% CI: 1.17–6.09), pre-information about distribution (AOR: 4.08, 95% CI: 2.13–7.81), product adequacy (AOR: 5.12, 95% CI: 2.36–11.13), and waiting time (AOR: 0.98, 95% CI: 0.96–0.99). A walking distance of less than 30 minutes (AOR: 4.18; 95% CI: 1.74, 10.02) or 30–59 minutes (AOR: 4.33; 95% CI: 1.73, 10.8) to the distribution center increased the likelihood of regular FBF use compared to distances over an hour.
Conclusion
While message and contact coverage were high, fewer than half of the participants utilized FBF regularly. Logistical and programmatic issues hinder regular utilization. Addressing supply chain challenges, improving distribution logistics, and raising awareness about FBF benefits can enhance program effectiveness. Future research should explore strategies to overcome these barriers and optimize nutritional outcomes in similar settings.