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

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 Shah
Resource type:
Peer review

This study evaluates the impact of the Pushtikona-5 program, a market-based home fortification initiative using micronutrient powder (MNP) in Bangladesh. Using a modified stepped-wedge design, surveys were conducted at baseline, midline, and endline. The prevalence of anemia decreased from 46.6% at baseline to 32.1% at midline and 31.2% at endline. MNP coverage and consumption also increased over the study period. The findings suggest a significant reduction in anemia prevalence and improved program coverage, demonstrating the feasibility and impact of integrating market-based MNP distribution with infant and young child feeding promotion through community health workers.

Top 5 points discussed :

1. Positive Outcomes: The study shows a reduction in anemia prevalence and increased coverage of Pushtikona-5, but the anemia reduction isn't solely due to Pushtikona-5.

2. Combined Interventions: The combined approach of promoting feeding practices and using Multiple Micronutrient Powder (MNP) may have contributed to anemia reduction, though causality is challenging to establish without a comparison group.

3. Success of Market-Based Model: The market-based model for MNP distribution, dependent on community health workers, demonstrated effectiveness, emphasizing the importance of operational quality.

4. Challenges in IYCF Practices: Infant and Young Child Feeding (IYCF) practices initially improved but plateaued, possibly influenced by incentives promoting Pushtikona-5.

5. Considerations for Program Implementation: The evaluation underscores the need to address factors influencing low home visits by community health workers and emphasizes cautious integration of MNP and IYCF programs to avoid unintended consequences.