Uptake of preventive nutrition interventions among caretakers of children under 5 years in a pastoral setting of South Sudan.

Abstract

Background: Preventive nutrition interventions (PNI) are usually implemented without understanding how multilevel factors affect uptake. Undernutrition is defined as inadequate intake of nutritious foods. Pastoral populations in conflict settings are seen to have low uptake. The study assessed the level and multiple factors influencing the uptake of PNI in caregivers of under 5 in Kapoeta South County of South Sudan.

Methods: A quantitative approach was employed with an element of a qualitative in a socio-ecological framework. A total of 405 caretakers of CU5 were selected to respond to quantitative household interviews, while qualitative data was collected using KIIs. Primary data were collected through structured questionnaires, which were used to attain quantitative data. The data collected through the method of KII were of qualitative type. Using deductive thematic analysis approach, the quantitative data were coded into personal, interpersonal, and community-level factors, and the analysis was done using STATA software version 16. A technique for constructing the uptake level as low, medium, or high was factor analysis. With the result of the binary logistic regression to determine association. Furthermore, semi-structured KIIs were conducted and the qualitative information analyzed thematically to elaborate on the quantitative results.

Result: The uptake level of the Preventive Nutrition Interventions (PNIs) was low at 51. 4%. In the socioecological system, facilitators and barriers related to this uptake differed across the benchmarks of that model. At the community level however, lack of a health facility within the community (OR = 1. 63, C. I. = 1. 02-2. 59) and the time taken before one can access a health facility (OR = 1. 70, C. I = 1. 30-2. 23) showed that accessibility could encourage uptake of PNIs. In the interpersonal dimension, joint decision makers at the family level (OR = 0. 31, C. I = 0. 19-0. 50) had higher uptake. Three factors at the individual level revealed that low uptake was inversely related to caregivers' knowledge of PNIs (OR = 0. 16, C. I. = 0. 10-0. 25), but positively related to having an undernourished child (OR = 2. 59, C. I. = 1. 73-3. 89), as well as number of children in the household (OR = 0. 40, C. I. = 0. 26). KIIs validate that undernutrition and practical issues were the main determinant of PNI uptake.

Conclusion: This study found that caretakers of children under 5 years reported low knowledge of and uptake to preventive nutrition interventions (PNIs) among the pastoral population in South Sudan. Based on the proposed socioecological model, we recommend that PNI approaches need to target multiple levels. At the community level, the focus is on improving access to health facilities and reducing the travel time to these facilities. Another way to increase intervention uptake is to improve spousal-supported joint decisions at the interpersonal level. Enhancing the awareness of the target audience and providing them with relevant information can impact the utilization rates of PNIs at the individual level. Therefore, nutrition stakeholders should employ an approach that targets community, interpersonal, and individual levels with the purpose of increasing PNI uptake.