Sale of micronutrient powders (MNPs) by frontline workers (FLWs) enables high reach, but low uptake limits impact on anemia and iron status: a cluster randomized study in Bangladesh


Little is known about how different delivery platforms can be used to reach nutritionally at risk populations with MNPs. A cluster randomized design was used to examine impact, on anemia and iron deficiency (ID), of the sale of MNPs by BRAC FLWs - MNP intervention, and/or enhanced nutrition interpersonal counseling (IPC) - EIPC intervention. Cross-sectional surveys at baseline (2010) and endline (2014) were conducted in children 6-11 mo at baseline and endline, and cluster adjusted difference-in-difference analysis was used to estimate impact.

Compared to the control group, there were no significant differences in changes in Hb (9.9 → 9.7 g/dL vs. 9.9 → 9.8 g.dL, p = n.s.) or adjusted serum ferritin (SF) conc. over time (26.9 → 21.8 ug/L vs. 24.6 → 20.2 ug/L, p = n.s.) in the MNP + EIPC group, and in the prev. of anemia (67.5 → 71.6% vs. 67.2 → 75.3%, p = n.s.) or ID (11.0 → 22.9% vs.14.7 → 28.8%, p = n.s.). In the MNP + EIPC group FLW reach was high (~90%), as was awareness of MNPs (71.9%). In this group, 50% of HHs reported ever purchasing MNPs; mean purchase in the last 6 mo was 12.1 sachets; mean consumption in the last 7 d was 1.0 sachets.

Among high target children 6-7 mo of age, only 8.3% of children were classified as regular consumers (>2 sachets in the previous 7 d). Lack of awareness of the benefits of MNPs and cost were identified as barriers to purchase and use. The lack of impact on anemia and ID appears driven by low purchase, despite high reach of the FLW network, pointing to the potential of this platform if efforts aimed at increasing demand creation and affordability are strengthened. 

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