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Sarma H, Rahman M, Tariqujjaman M, Islam MA, Mbuya MNN, Aaron GJ, Askari S, Harbour C, Khondker R, Bipul M, Sultana S, Rahman MA, Shahin SA, Chowdhury M, Afsana K, Ghosh S, Banwell C, D’Este C, Salasibew M, Neufeld LM, Ahmed T. Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design. Front Nutr 2024; 10:1271931. [PMID: 38249611 PMCID: PMC10796820 DOI: 10.3389/fnut.2023.1271931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Anemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) on the prevalence of anemia among children aged 6-59 months in Bangladesh. Methods We used a modified stepped wedged design and conducted three baseline, two midline, and three endline surveys to evaluate the Pushtikona-5 program implemented through three BRAC program platforms. We interviewed children's caregivers, and collected finger-prick blood samples from children to measure hemoglobin concentration. We also collected data on coverage of Pushtikona-5 and infant and young child feeding (IYCF) practices. We performed bivariate and multivariable analysis and calculated adjusted risk ratios (ARRs) to assess the effect of program outcomes. Results A total of 16,936 households were surveyed. The prevalence of anemia was 46.6% at baseline, dropping to 32.1% at midline and 31.2% at endline. These represented adjusted relative reductions of 34% at midline (RR 0.66, 95%CI 0.62 to 0.71, value of p <0.001) and 32% at endline (RR 0.68, 95%CI 0.64 to 0.71, value of p <0.001) relative to baseline. Regarding MNP coverage, at baseline, 43.5% of caregivers surveyed had heard about MNP; 24.3% of children had ever consumed food with MNP, and only 1.8% had consumed three or more sachets in the 7 days preceding the survey. These increased to 63.0, 36.9, and 4.6%, respectively, at midline and 90.6, 68.9, and 11.5%, respectively, at endline. Conclusion These results show evidence of a reduction in the prevalence of anemia and an improvement in coverage. This study provides important evidence of the feasibility and potential for impact of linking market-based MNP distribution with IYCF promotion through community level health workers.
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Affiliation(s)
- Haribondhu Sarma
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | - Grant J. Aaron
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Sufia Askari
- Maternal Child Health & Nutrition, Sight and Life, Geneva, Switzerland
- The Children’s Investment Fund Foundation, London, United Kingdom
| | | | | | | | - Sabiha Sultana
- Global Alliance for Improved Nutrition, Dhaka, Bangladesh
| | | | | | | | - Kaosar Afsana
- Health, Nutrition and Population Program, BRAC, Dhaka, Bangladesh
| | - Samik Ghosh
- The Children’s Investment Fund Foundation, London, United Kingdom
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
| | | | | | - Tahmeed Ahmed
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
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Senbanjo IO, Owolabi AJ, Oshikoya KA, Hageman JHJ, Adeniyi Y, Samuel F, Melse-Boonstra A, Schaafsma A. Effect of a Fortified Dairy-Based Drink on Micronutrient Status, Growth, and Cognitive Development of Nigerian Toddlers- A Dose-Response Study. Front Nutr 2022; 9:864856. [PMID: 35571933 PMCID: PMC9097016 DOI: 10.3389/fnut.2022.864856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Malnutrition results in a high prevalence of stunting, underweight, and micronutrient deficiencies. This study investigated the effect of a multi-nutrient fortified dairy-based drink on micronutrient status, growth, and cognitive development in malnourished [height-for-age z-score (HAZ) and/or weight-for-age z-score (WAZ) < -1 SD and >−3 SD] Nigerian toddlers (n = 184, 1–3 years). The product was provided in different daily amounts (200, 400, or 600 ml) for 6 months. At baseline and endline, venous blood and urine samples were collected to determine micronutrient status. Bodyweight, height, waist, and head circumference were measured, and corresponding Z-scores were calculated. The Bayley-III Screening Test was used to classify the cognitive development of the children. In a modified per-protocol (PP) population, the highest prevalence's of micronutrient deficiencies were found for vitamin A (35.5%) and selenium (17.9%). At endline, there were no significant improvements in iodine, zinc, vitamin B12, and folate status in any of the three groups. Regarding vitamin D status (25OHD), consumption of 600 and 400 ml resulted in an improved status as compared to baseline, and in a difference between the 600- and 200-ml groups. Consumption of 600 ml also increased vitamin A and selenium status as compared to baseline, but no differences were found between groups. Within the groups, WAZ, weight-for-height z-score (WHZ), and BMI-for-age z-score (BAZ) improved, but without differences between the groups. For HAZ, only the 600 ml group showed improvement within the group, but it was not different between groups. For the absolute weight, height, and head circumference only trends for differences between groups were indicated. Cognition results did not differ between the groups. Within groups, all showed a decline in the per cent of competent children for receptive language. To study the effects of a nutritional intervention on linear growth and cognition, a longer study duration might be necessary. Regarding the improvement of micronutrient status, 600 ml of fortified dairy-based drink seems most effective.
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Affiliation(s)
- Idowu Odunayo Senbanjo
- Department of Paediatrics and Child Health, Paediatric Gastroenterology, Hepatology and Nutrition Unit, Lagos State University College of Medicine, Lagos, Nigeria
| | - Adedotun J. Owolabi
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Kazeem Adeola Oshikoya
- Department of Pharmacology, Therapeutic and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Yetunde Adeniyi
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Folake Samuel
- Department of Human Nutrition, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Anne Schaafsma
- FrieslandCampina, Amersfoort, Netherlands
- *Correspondence: Anne Schaafsma
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