Randomized control trials demonstrate that nutrition-sensitive social protection interventions increase the use of multiple-micronutrient powders and iron supplements in rural pre-school Bangladeshi children.

John Hoddinott,Shalini Roy,Akhter Ahmed

doi:10.1017/s1368980017004232

Abstract

To examine the impact of a nutrition-sensitive social protection intervention on mothers' knowledge of Fe deficiency, awareness of multiple-micronutrient powders (MMP) and the consumption of MMP and other Fe supplements by their children aged 6-59 months. Two randomized controlled trials with treatment arms including cash transfers, food transfers, cash and food transfers, cash and nutrition behaviour change communication (BCC), and food and nutrition BCC were implemented over two years. Both included a control group that received no transfer or BCC. Transfer recipients were mothers living in poor households with at least one child aged less than 2 years at baseline. Probit models were used to analyse endline data. Rural areas in north-west and south Bangladesh. Mothers (n 4840) and children 6-59 months (n 4840). A transfer accompanied by nutrition BCC increased the share of mothers with knowledge of Fe deficiency (11·9 and 9·2 percentage points for North and South, respectively, P≤0·01), maternal awareness of MMP (29·0 and 22·2 percentage points, P≤0·01), the likelihood that their children 6-59 months had ever consumed MMP (32 and 11·9 percentage points, P≤0·01), consumed MMP in the preceding week (16·9 and 3·9 percentage points, P≤0·01) and consumed either MMP or an Fe supplement in the preceding week (22·3 and 7·1 percentage points, P≤0·01). Improvements were statistically significant relative to groups that received a transfer only. Nutrition-sensitive social protection (transfers with BCC added) may be a promising way to advance progress on micronutrient deficiencies.

Highlights

In the North, study villages were randomly assigned to a control group or one of four treatment arms in which beneficiaries received one of the following monthly: (i) a cash transfer of 1500 Taka (‘cash transfer of Taka (Cash)’), approximately $US 19 and equivalent to approximately 25 % of average monthly household consumption expenditures of poor rural households in Bangladesh[12]; (ii) an equal-value food ration consisting of rice, lentils and micronutrient-fortified cooking oil (‘Food’); (iii) a half cash transfer and half food ration (‘Cash & Food’); or (iv) the cash transfer along with nutrition behaviour change communication (BCC) (‘Cash + BCC’; see Figs 1 and 2 for further details)
Programme implementation Quantitative data collected throughout the intervention indicated that the Transfer Modality Research Initiative (TMRI) transfers and BCC were implemented as designed
We found that a transfer accompanied by high-quality nutrition BCC improved mothers’ average knowledge of Fe deficiency and awareness of multiplemicronutrient powders (MMP), as well as significantly increased the likelihood of their children aged 6–59 months consuming MMP or some other Fe supplement in the preceding week

Summary

Introduction

We conducted ANCOVA estimates for the impact of different treatment arms at endline on mothers’ knowledge of the consequences of insufficient Fe intake and on their familiarity with MMP controlling for baseline levels of maternal knowledge regarding the consequences of Fe deficiency, as well as other baseline maternal characteristics (age and grade of formal schooling) and household characteristics (log value (in Taka) of production assets and consumer durables; household size; whether the household is female headed). In the North, across all treatment arms the sample is balanced across baseline household characteristics, baseline maternal characteristics (including knowledge of Fe deficiency in children and awareness of MMP), and endline child age and sex (Table 1).

Results

Conclusion