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

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

doi:10.3389/fnut.2023.1271931

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

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

Authors

Haribondhu Sarma^{1

2}, Mahfuzur Rahman², Md Tariqujjaman², Mohammad Ashraful Islam², Mduduzi N N Mbuya³, Grant J Aaron⁴, Sufia Askari^{5

6}, Catherine Harbour⁶, Rudaba Khondker⁷, Moniruzzaman Bipul⁷, Sabiha Sultana⁷, Mohammad Ashikur Rahman⁸, Shaima Arzuman Shahin⁸, Morseda Chowdhury⁸, Kaosar Afsana⁸, Samik Ghosh⁶, Cathy Banwell¹, Catherine D'Este¹, Mihretab Salasibew⁶, Lynnette M Neufeld⁴, Tahmeed Ahmed²

Affiliations

¹ National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia.
² Nutrition Research Division, icddr,b, Dhaka, Bangladesh.
³ Global Alliance for Improved Nutrition, Washington, DC, United States.
⁴ Global Alliance for Improved Nutrition, Geneva, Switzerland.
⁵ Maternal Child Health & Nutrition, Sight and Life, Geneva, Switzerland.
⁶ The Children's Investment Fund Foundation, London, United Kingdom.
⁷ Global Alliance for Improved Nutrition, Dhaka, Bangladesh.
⁸ Health, Nutrition and Population Program, BRAC, Dhaka, Bangladesh.

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.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was funded by the Children’s Investment Fund Foundation (CIFF), UK (Grant number GR-01136).