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. 2024 Jan 5:10:1271931.
doi: 10.3389/fnut.2023.1271931. eCollection 2023.

Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design

Haribondhu Sarma  1   2 , Mahfuzur Rahman  2 , Md Tariqujjaman  2 , Mohammad Ashraful Islam  2 , Mduduzi N N Mbuya  3 , Grant J Aaron  4 , Sufia Askari  5   6 , Catherine Harbour  6 , Rudaba Khondker  7 , Moniruzzaman Bipul  7 , Sabiha Sultana  7 , Mohammad Ashikur Rahman  8 , Shaima Arzuman Shahin  8 , Morseda Chowdhury  8 , Kaosar Afsana  8 , Samik Ghosh  6 , Cathy Banwell  1 , Catherine D'Este  1 , Mihretab Salasibew  6 , Lynnette M Neufeld  4 , Tahmeed Ahmed  2
Affiliations

Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design

Haribondhu Sarma et al. Front Nutr. .

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.

Keywords: Bangladesh; anemia; children; home fortification; market-based program; micronutrient powder.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Survey design and timeline of baseline, midline, and endline surveys in three program platforms.
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