Effectiveness of Workplace Nutrition Programs on Anemia Status among Female Readymade Garment Workers in Bangladesh: A Program Evaluation

Abstract

Eight in ten female readymade garment (RMG) workers in Bangladesh suffer from anemia, a condition which damages both health and productivity. This study evaluated the effectiveness of a workplace nutrition program on anemia reduction in female RMG workers of Bangladesh. A quasi-experimental mixed method study was conducted on 1310 non-pregnant female RMG workers from four factories. Two types of intervention packages (A and C) were tested against their respective controls (B and D) over a 10-month period. Among factories that already provided lunch to workers with regular behavior change counseling (BCC), one intervention (A) and one control (B) factory were selected, and among factories that did not provide lunches to their workers but provided regular BCC, one intervention (C) and one control (D) factory were selected: (A) Lunch meal intervention package: daily nutritionally-enhanced (with fortified rice) hot lunch, once weekly iron-folic acid (IFA) supplement and monthly enhanced (with nutrition module) behavior change counseling (BCC) versus (B) Lunch meal control package: regular lunch and BCC; and (C) Non-meal intervention package: twice-weekly IFA and enhanced BCC versus (D) Non-meal control package: BCC alone. Body weight and capillary hemoglobin were measured. Changes in anemia prevalence were estimated by difference-in-difference (DID) method. Thematic analysis of qualitative in-depth interviews with RMG workers was performed and findings were triangulated. Anemia was reduced significantly in both lunch meal and non-meal intervention (A and C) group (DID: 32 and 12 percentage points, p: <0.001 and <0.05 respectively). The mean hemoglobin concentration also significantly increased by 1 gm/dL and 0.4 gm/dL in both A and C group (p: <0.001 respectively). Weight did not change in the intervention groups (A and C) but significantly increased by more than 1.5 kg in the comparison groups (B and D). The knowledge of different vitamin and mineral containing foods and their benefits was increased significantly among all participants. Workplace nutrition programs can reduce anemia in female RMG workers, with the greatest benefits observed when both nutritionally enhanced lunches and IFA supplements are provided.

Youth and Food Systems Transformation

“…They may consume a greater proportion of food outside the home (e.g., street food and fast food, or meals in institutional canteens). Sites such as schools, gyms and workplaces may exert an influence over young people's food choices, whether through providing food or exposing the young people to guidance on nutrition and healthy eating (Fernandes et al, 2017;Hossain et al, 2019). Participating in activities and employment away from home will also expose young people to positive and negative influences via peer pressure and other social and cultural signals, including food marketing, which typically promotes highly processed, energy dense, "empty calorie" foods (WHO, 2006;Popkin et al, 2012;Marcus, 2013; Save the Children, 2015; Development Initiatives, 2018).…”

Exploring food security and nutrition among young women in the formally regulated garment sector of Myanmar

“…In the effectiveness study of workplace nutrition programs in RMG factories, nutritious lunch enhanced with fortified rice, along with weekly iron and folic acid (IFA) supplementation, had the most significant impact on anemia levels compared with regular lunch and behavioral change communication (BCC). 24 These findings could inform national legislation obliging factory owners to operate canteens or provide nutritious meals in other ways and support national guidelines on meal provision in garment factories.…”

“…Previous work on supplementation interventions in the workplace has demonstrated the effectiveness of a weekly dose of IFA, with or without vitamin C, on anemia reduction and increased productivity, 15,24 but not of increasing consumption of iddli, a popular cereal-based fermented food, or of gooseberry juice in India. 25 The use of fortified staples, for example, fortified rice, which is already produced and available in Myanmar, or snacks rich in vitamins, could be tested in such a setting to provide data for cost-benefit analysis.…”

“…In an effectiveness study of workplace nutrition programs on anemia status in RMG workers, there was an increase by 6% of anemia among women in the BCC promotion alone intervention (the study compared twiceweekly IFA supplementation and enhanced BCC versus BCC alone). 24 In the workplace, nutrition promotion intervention along with cues near the purchasing point (e.g., information sheet by the canteen or vending machine) can improve the social acceptability of healthy diets and support the intention to change behaviors. 32 In a systematic review, 33 worksite interventions promoting healthier food and/or physical activity habits among employees showed acceptable effectiveness when the interventions were done in the community as well.…”

Food Systems for Healthier Diets in Bangladesh: Towards a Research Agenda

“…Finally, a pilot intervention was recently carried out in garment factories that provide lunch and those that do not provide lunch for their female employees to test whether a supplement or a supplement plus lunch can be effective at reducing anemia (Hossain et al, 2019). The intervention found reduced anemia by 32 percentage points in the lunch group and 12 percentage points in the non-lunch group, respectively, relative to a control group.…”