Formative research and effectiveness study for the development of a home fortification programme for young children in Zambia (supported by Irish Aid through UNICEF Zambia, the Ministry of Health and University of British Columbia)
Background
Zambia has signed on to the Scaling up Nutrition (SUN) movement and the government is committed to reducing undernutrition among children. As measured by underweight, and other indicators of nutritional status, particularly stunting and anaemia, there has been little remained change over the past decades. There has been no significant reduction in anaemia among children under five years of age over the past two decades with an estimated prevalence of 60% in 1998, 53% in 2003 49% in 2009 and 55% in 2012 (National Survey on Anaemia in Zambia 1998, MIS 2009 and 2012). Home fortification of staple complementary foods, which are primarily maize based, is considered the most promising strategy for reducing anaemia among young children. Single use sachets of highly bioavailable vitamins and minerals that can be easily mixed with a child’s home-prepared food just before consumption. While Micronutrient Powders are primarily designed to control micronutrient deficiencies, particularly iron deficiency, and not the problem of stunting, their integration with an infant and young child feeding protocol provides an opportunity for promoting key practices that have the potential to contribute to improved child growth and development.
Our work
Nourish team members provided technical support to the Government of Zambia and UNICEF to develop home fortification with MNP for young children as part of a multi-phase project. The first phase consisted of two components, a feasibility study and a 30-day trial of MNP. The feasibility study included key informant interviews and focus group discussions, which assessed current feeding practices, local perceptions of the intervention, potential barriers to introduction, knowledge of anaemia, and tested local package designs. The second component, a 30-day home feeding trial assessed the acceptability and utilization of MNP among 60 households using two different delivery strategies.
During the pilot programme that followed, our team conducted a 12-month effectiveness study to assess the impact of the intervention on rates of anaemia and other nutritional indicators. In the study, MNP were provided to caregivers in an intervention group along with training on infant and young child feeding practices and insecticide treated nets. The control group received the same treatment with the exception of the micronutrient powders. Data collected included anthropometrics, haemoglobin concentration, as well as household information collected via a questionnaire that was answered by caregivers of the children enrolled in the study. The results of the study provided valuable information to build an effective system of physical delivery of MNP, community sensitization, and the required education of caregivers and other members of the community.
