Changes in growth, anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post‐pilot scale‐up of an integrated infant and young child feeding and micronutrient powder intervention

Abstract

There is limited research on integrated infant and young child feeding (IYCF) and micronutrient powders (MNPs) programmes operating at scale, despite widespread implementation. This study uses cross‐sectional baseline ( n = 2,542) and endline ( n = 2,578) surveys representative of children 6–23 months in two districts in Nepal that were part of a post‐pilot scale‐up of a IYCF–MNP programme. Multivariable log‐binomial regression models were used to estimate prevalence ratios (PRs) for stunting (length‐for‐age z ‐score <−2), wasting (weight‐for‐length z ‐score <−2), underweight (weight‐for‐age z ‐score <−2), anaemia (altitude‐adjusted haemoglobin <110 μg/L), moderate or severe anaemia (altitude‐adjusted haemoglobin <100 g/L), iron deficiency (inflammation‐adjusted ferritin <12 μg/L), and iron deficiency anaemia (iron deficiency + anaemia [IDA]) at endline versus baseline and also to compare children in the endline survey based on frequency of mothers' interactions with female community health volunteers (FCHVs; >1× per month or monthly vs. <1× per month) and MNP coverage (1 or ≥2 distributions vs. none among children 12–23 months). Endline children were significantly less likely to be stunted than baseline children in both districts (multivariable‐adjusted PR [95% CI]: 0.77 [0.69, 0.85], P < 0.001 and 0.82 [0.75, 0.91], P < 0.001 in Kapilvastu and Achham, respectively); however, only Achham had significantly lower prevalences of underweight, moderate/severe anaemia, iron deficiency, and IDA at endline. At endline, 53.5% and 71.4% of children had tried MNP in Kapilvastu and Achham districts, respectively, consuming an average of 24 sachets from the last distribution. Frequent maternal–FCHV interactions were associated with a reduced risk of stunting and underweight at endline, whereas repeat MNP coverage was associated with reduced risk of anaemia and IDA. Future research using experimental designs should verify the potential of integrated IYCF–MNP programmes to improve children's nutritional status.

Associations of Knowledge, Attitude, and Practices toward Anemia with Anemia Prevalence and Height-for-Age Z-Score among Indonesian Adolescent Girls

“…An intervention study in Nepal showed that micronutrient powders, containing various vitamins and minerals, decreased both stunting and anemia prevalence in children. 53 Nutrient intake and dietary diversity improvement in anemia prevention conducted in Malawi were also shown to improve HAZ and reduce stunting prevalence. 54 Also, hygiene affects both anemia and stunting.…”

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey

“…These meetings are unique platforms to discuss different health issues and are attended by local women. Studies from Nepal have shown that frequent interactions between mothers and FCHVs were related to the use of child health services from FCHVs [12] and reduction in underweight and stunting status among children [27]. Similarly, a study from Makwanpur, Nepal [28] and Jharkhand and Orissa of India [29] had shown that participatory intervention involving women's group can decrease both maternal and neonatal mortality and improve service utilization.…”

Factors associated with child health service delivery by female community health volunteers in Nepal: Findings from a national survey

“…These meetings are unique platforms to discuss different health issues and are attended by local women. Studies from Nepal have shown that frequent interactions between mothers and FCHVs were related to the use of child health services from FCHVs [20] and reduction in underweight and stunting status among children [28].…”