Investigator(s)
| Submitter |
Nidup Dorji Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan Nidup Dorji 
|
| Principal Investigator |
Nidup Dorji Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan Nidup Dorji
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| Co-Investigator(s) |
Wangchuk Wangchuk Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan Wangchuk Wangchuk
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| Co-Investigator(s) |
Bhawane Shankar Dungana Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan Bhawane Shankar Dungana
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| Co-Investigator(s) |
Hari Prasad Pokhrel Ministry of Health, Thimphu, Bhutan Hari Prasad Pokhrel
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Title(s) and abstract
| Scientific title | COMPLIANCE, KNOWLEDGE, ATTITUDES, AND PRACTICES RELATED TO MULTIPLE MICRONUTRIENT SUPPLEMENTS (MMS) AND MICRONUTRIENT POWDER (MNP) AMONG PREGNANT AND LACTATING WOMEN, PRIMARY CAREGIVERS, AND HEALTH WORKERS IN BHUTAN |
| Public title | Adherence, knowledge, attitude, and practice about multiple micronutrient in Bhutan |
| Background | Micronutrient deficiencies often mentioned “hidden hunger” remain as a critical global health challenge, affecting over two billion people worldwide, particularly young children and pregnant or lactating women in low and middle-income countries (LMICs). Despite global commitments such as Sustainable Development Goals (SDGs) 2 and 3, progress toward ending hunger and ensuring health for all remains uneven. Anemia among women of reproductive age rose from 31.6% in 2000 to 32.8% in 2016, contributing to over 300,000 maternal deaths annually. Each year, approximately 20.5 million infants are born with low birth weight, and in 2022, an estimated 149 million children were stunted, 45 million wasted, and 37 million overweight. This illustrates the global triple burden of malnutrition. These deficiencies stem from inadequate intake of essential micronutrients such as iron, zinc, vitamin A, folate, iodine, calcium, and vitamin D - nutrients vital for immunity, growth, and cognitive development. In South Asia, home to one-third of the world’s undernourished children, about one in four women of reproductive age (307 million) are affected by micronutrient deficiencies. Poor maternal education, socio-economic status, and inadequate health service contact further exacerbate poor feeding practices. In Bhutan, notable progress has been achieved, with undernutrition among children under five declining from 33.5% in 2010 to 17.9% in 2023. However, underweight (8.7%) and wasting (5.1%) persist. Vitamin D deficiency affects 91.4% of the population, alongside ferritin (50.6%), folate (38.1%), vitamin B12 (29.5%), and calcium (19.7%) deficiencies. Anemia remains widespread, affecting 44.7% of children under five, 36.5% of adolescent girls, 33.3% of pregnant women, and 40.9% of women of reproductive age. Despite multiple micronutrient initiatives, Bhutan lacks comprehensive studies on adherence and acceptability. This study is envisaged to inform program effectiveness backed up by scientific evidence, policy interventions to reduce the nation’s micronutrient burden. |
| Objectives | 1. Assess compliance of MMS/MNP usage among pregnant/lactating women (PLW) and primary caregivers of children 6-23 months in Bhutan. 2. Evaluate the level of knowledge, attitudes, and practices (KAP) among pregnant/lactating women (PLW) and primary caregivers of children 6-23 months in Bhutan. 3. Assess healthcare providers’ KAP related to MMS/MNP delivery and counseling. 4. Examine the relationship between socio-demographic variables, KAP, barriers, MMS/MNP compliance and usage. 5. Explore perceived benefits, barriers, and challenges (CIFR) affecting MMS/MNP adoption and sustainability. |
| Study Methods | This study will employ an explanatory sequential mixed-method design (beginning with quantitative and followed by qualitative study) to assess the level of adherence, knowledge, attitude, practice, perceived benefits, challenges and barriers related to MMS use among the pregnant and lactating women (PLW) and MNP use among the primary caregivers of children 6-23 months; knowledge, attitude, and practice related to MMS and MNP delivery and counseling among the healthcare providers in Bhutan. The trained research assistants will employ face-to-face interview, Focus Group Discussion (FGD), and in-depth interview (IDI) to collect data from the study sites across Bhutan. Both descriptive and inferential statistical analyses will be performed to describe and assess associations between the study variables with p< 0.05 considered significant throughout the analysis. |
| Expected outcomes and use of results | It is envisaged that the conduct of this study could generate a baseline estimate of MNP and MMS compliance among targeted population of pregnant and lactating women, primary caregivers of children 6-23 years, and healthcare providers in Bhutan. The study also expects to identify key facilitators and barriers to MNP/MMS compliance at the household, community, and system levels. Furthermore, the findings will provide evidence-based policy recommendations to optimize the delivery and uptake of MNP and MMS programs. Finally, the study will offer data-backed justification for the inclusion of MMS in the National Essential Medicine List (NEML). |
| Keywords | Micronutrient deficiencies, adherence, anemia, multiple micronutrient supplement, multiple micronutrient powder, healthcare provider, Bhutan. |
Research Details
| Student research | No |
| Start Date | 01-Dec-2025 |
| End Date | 15-Feb-2026 |
| Key Implementing Institution | Khesar Gyalpo University of Medical Sciences |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Maternal, Reproductive and Child Health |
| Research field(s) | Child Health, Nutrition, Reproductive Health, Health Care Seeking/Utilization |
| Involves human subjects | Yes |
| Operational Research, Qualitative Study | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | No |