The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6-23 Months in Madagascar.

Lindsey Locks,Ietje Reerink,Smaila Gnegne,Simeon Nanama,Aashima Garg,Noelimanjaka Ramalanjaona,Amal Tucker Brown,Christopher Duggan

doi:10.3390/nu9060581

Abstract

This study assesses the impact of an integrated infant and young child feeding (IYCF) and micronutrient powder (MNP) intervention on children’s risk of anemia and IYCF practices in Madagascar. Quantitative baseline and endline surveys were conducted in representative households with children 6–23 months from two districts, where an 18-month IYCF-MNP intervention was implemented. Relative risks comparing children’s risk of anemia and maternal IYCF knowledge and practices at baseline versus endline, and also at endline among MNP-users versus non-users were estimated using log-binomial regression models. 372 and 475 children aged 6–23 months were assessed at baseline and endline respectively. Prevalence of anemia fell from 75.3% to 64.9% from baseline to endline (p = 0.002); the reduction in the risk of anemia remained significant in models adjusting for sociodemographic characteristics (ARR (95% CI): 0.86 (0.78, 0.95), p = 0.003). In endline assessments, 229 out of 474 (48.3%) of children had consumed MNPs. MNP-users had a lower risk of anemia (ARR (95% CI): 0.86 (0.74, 0.99), p = 0.04) than non-users, after controlling for child’s dietary diversity and morbidity, maternal counseling by community-health-workers, and sociodemographic characteristics. Mothers interviewed at endline also had greater nutrition knowledge and were more likely to feed their children ≥4 food groups (ARR (95% CI): 2.92 (2.24, 3.80), p < 0.001), and the minimum acceptable diet (ARR (95% CI): 2.88 (2.17, 3.82), p < 0.001) than mothers interviewed at baseline. Integration of MNP into IYCF interventions is a viable strategy for improving children’s consumption of micronutrients and reducing risk of anemia. The addition of MNP does not negatively impact, and may improve, IYCF practices.

Highlights

Over two billion people are deficient in key vitamins and minerals, vitamin A, iodine, iron and zinc [1]
In this study of representative households with children aged 6–23 months from the two rural districts in Madagascar where Project Fortidom, an integrated infant and young child feeding (IYCF)-micronutrient powder (MNP) intervention, was implemented, we found that the risk of anemia among children aged 6–23 months was significantly lower at endline than baseline
In models controlling for demographic characteristics, maternal community-health workers (CHWs) exposure and child’s dietary diversity, we found that children who consumed MNP had a significantly higher mean hemoglobin levels and a lower risk of anemia

Summary

Introduction

Over two billion people are deficient in key vitamins and minerals, vitamin A, iodine, iron and zinc [1]. The efficacy of MNPs has been well-established as demonstrated by recent meta-analyses of trials in children under 2 years [7,8] which concluded that prolonged, regular use of MNPs can reduce the prevalence of anemia by more than 25% and iron deficiency by more than 50%. Despite the fact that MNP programs reach millions of children each year [9], there are only a handful of studies that have assessed how to best implement programs using MNPs at scale [10,11,12,13,14,15,16]

Methods

Results

Discussion

Conclusion