Evaluating the Feasibility and Effectiveness of a Service Delivery Model for Home Fortification of Children aged 6-24 months

By Lindsey Peugh, Research Associate – ICTPH

In past blog posts we’ve discussed the large presence of nutritional deficiencies, particularly iron deficiency anaemia, among children across India. Such nutritional deficiencies can cause deleterious and irreversible effects on a child’s growth and development, especially during the critical stage of development between 6 and 24 months of age. It is recommended that infants be exclusively breastfed from birth until 6 months of age, after which complementary foods should be added to the infant’s diet. However, these complementary foods do not always provide adequate nutrients for the growing child. For instance, in low-income regions of the world, iron density in food is usually between 4.5-7.5 mg per 1,000 kcal (the recommended intake for children is 11mg/day) and is largely composed of poorly absorbed iron from grains, fruits, and vegetables. When complementary foods fail to provide the recommended intake of essential micronutrients, research recommends micronutrient supplementation as a strategy to combat micronutrient deficiencies in children under five years of age.

With all this in mind, ICTPH is designing a community-based intervention to reduce the prevalence of anaemia among the 6-24 month age group. As part of a long-term nutrition project, we will be conducting a pilot study in Thanjavur district to assess a service delivery model of a home-fortification powder called Sprinkles. Though iron supplement drops and tablets are available through the Integrated Child Development System and the local PHCs, the utilisation of these modes of supplementation are low due to unpleasant side effects, dispensation difficulties and other unfavourable factors. Sprinkles, a microencapsulated powder developed by Micronutrient Initiative, is a safe, easy to use, flavourless micronutrient powder that is added to complementary foods in the home. The powder is contained in sachets and it is recommended that 60 sachets be used over a course of 60-120 days. Evidence has shown that a short course (60 days) delivery of Sprinkles Anaemia Formulation (with 12.5 mg iron) effectively raises blood haemoglobin levels and reduces the prevalence of anaemia among children for at least six months. Despite the evidence of its effectiveness however, research on specific delivery models of Sprinkles is limited, especially in the Indian context.

The distribution of Sprinkles in Thanjavur will be conducted through the ICTPH health systems model, utilising the strengths of our nurse-managed rural micro health centres (RMHC) and the network of SughaVazvhu Guides (SVGs). SVGs and nurses will conduct educational activities at the household and RMHC-level respectively to bring about health seeking behaviour and to build up demand for interventions that can mitigate the effects of anaemia on children’s health – with the aim of encouraging caregivers to purchase Sprinkles at the RMHC. Caregivers will be able to have their child’s nutritional status assessed at the RMHC as well as purchase Sprinkles or other nutritional supplement modes if they choose to. Additionally, SVGs will conduct follow-up visits at households to assess compliance with the Sprinkles regimen, side effects if any, and caregivers’ perceptions of the child’s nutritional status, product effectiveness, and the delivery model itself.

Through this pilot study, we hope to identify barriers and bottlenecks in the delivery and use of Sprinkles at the community level, particularly evaluating the feasibility, acceptability, and effectiveness of the model. This information will help to develop a robust channel to deliver effective messages, increase awareness of child nutrition and anaemia, and increase utilisation of proven strategies to decrease anaemia – all of which we hope to scale up to other areas eventually.