The preponderance of knowledge and perception factors identified likely reflects an underlying assumption by investigators that caregiver behaviour is primarily driven by these two aspects, which may result in emphasis on questions related to these in research related to adherence. To achieve greater impact we need to adopt a more cultural-ecological perspective to inform the design of programs that take into account a broader set of determinants. New studies that assess the progress across the impact pathway, particularly from caregiver adherence to biological outcomes would be useful to guide future program evaluation design, particularly where time or other constraints may limit potential to measure biological outcomes. Greater understanding of caregivers’ perceptions and other facilitators and constraints to adherence is also critical for designing and monitoring behavior change strategies to encourage MNP use.
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