Delivery of iron-fortified yoghurt, through a dairy value chain program, increases hemoglobin concentration among children 24 to 59 months old in Northern Senegal: A cluster-randomized control trial
Agnes Le Port, Tanguy Bernard, Melissa Hidrobo, Ousmane Birba, Rahul Rawat, Marie T Ruel, Agnes Le Port, Tanguy Bernard, Melissa Hidrobo, Ousmane Birba, Rahul Rawat, Marie T Ruel
Abstract
Background: Innovative strategies are needed to enhance the nutritional impact of agriculture. Value chain approaches, which use supply chains to add value (usually economic) to products as they move from producers to consumers, can be used to increase access to nutritious foods and improve nutritional status. This study tested whether a dairy value chain could be used to distribute a micronutrient-fortified yoghurt (MNFY) (conditional upon the producer supplying a minimum amount of cow milk/day) to improve hemoglobin and reduce anemia among preschool children in a remote area in Northern Senegal.
Methods: A cluster randomized control trial was used to compare 204 children (24 to 59 months of age at baseline) from households who received the MNFY coupled to a behavior change communication (BCC) campaign focusing on anemia prevention to 245 children from a control group (receiving BCC only) after one year. Randomization was done at the level of the family concession (households from the same family) (n = 321). Eligible households had a child of the target age and were willing to deliver milk to the dairy factory. Changes in anemia and hemoglobin between groups were assessed using mixed regression models.
Key findings: Anemia prevalence was very high at baseline (80%) and dropped to close to 60% at endline, with no differences between intervention groups. Hemoglobin increased by 0.55 g/dL, 95%CI (0.27; 0.84) more in the intervention compared to the control group after one year, in models that controlled for potentially confounding factors. The impact was greater (0.72 g/dL, 95%CI (0.34; 1.12)) for boys, compared to girls (0.38 g/dL, 95%CI (-0.03; 0.80)).
Conclusion: The dairy value chain was a successful strategy to distribute MNFY among pastoralists in Northern Senegal, and increase Hb concentrations among their children. This study is one of the first proofs of concept showing that a nutrition-sensitive agriculture value chain approach can contribute to improved child nutrition in a remote pastoralist population.
Trial registration: ClinicalTrials.gov NCT02079961.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
Figures
References
- Bailey R, West J, Black R. The Epidemiology of Global Micronutrient Deficiencies. Ann Nutr Metab. 2015;66:S22–33.
- Stoltzfus RJ. Iron Interventions for Women and Children in Low-income Countries. J Nutr. 2011;141:756S–762S. 10.3945/jn.110.128793
- Agence Nationale de la Statistique et de la Démographie (ANSD) [Senegal] and ICF International. Senegal Demographic and Health and Multiple Indicator Cluster Survey (EDS-MICS) 2010–2011 [Internet]. Mariland; 2012.
- Olney DK, Rawat R, Ruel MT. Identifying Potential Programs and Platforms to Deliver Multiple Micronutrient Interventions. J Nutr. 2012;142(1):178S–85S. 10.3945/jn.110.137182
- Feeley AB, Coly AN, Yaga N, Gueye S, Diop EI, Pries AM, et al. Promotion and consumption of commercially produced foods among children: situation analysis in an urban setting in Senegal. Matern Child Nutr. 2016;12:S64–76.
- Hawkes C, Ruel MT. Value Chains for Nutrition [Internet]. Leaveraging agriculture for improving nutrition and health. 2020 CONFERENCE BRIEF 4. 2011.
- Bhutta ZA, Das JK, Rizvi A, Gaff MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382:452–77. 10.1016/S0140-6736(13)60996-4
- Bernard T, Hidrobo M, Le Port A, Rawat R. Nutrition incentives in dairy contract farming in northern Senegal [Internet]. Field Exchange 51. 2016. p. 26.
- Carte sanitaire du Senegal [Internet]. 2011 [cited 2016 Dec 5].
- Parisse M. Developing local dairy production: the Laiterie du Berger, Senegal. Field Actions Science Reports. 2012.
- Guyon A, Quinn V, Nielsen J, Stone-Jimenez M. Essential Nutrition Actions and Essential Hygiene Actions Reference Materials on Key Practices: Community Workers [Internet]. 2015.
- Coates Jennifer S A and, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v. 3) [Internet]. Washington D.C; 2007.
- De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review). Cochrane Database Syst Rev [Internet]. 2011;(9). Available from:
- Macharia-Mutie CW, Moretti D, Van Den Briel N, Omusundi AM, Mwangi AM, Kok FJ, et al. Maize Porridge Enriched with a Micronutrient Powder Containing Low-Dose Iron as NaFeEDTA but Not Amaranth Grain Flour Reduces Anemia and Iron Deficiency in Kenyan Preschool Children. J Nutr. 2012;142:1756–63. 10.3945/jn.112.157578
- Gera T, Sachdev HS, Boy E. Effect of iron-fortified foods on hematologic and biological outcomes: systematic review of randomized controlled trials. Am J Clin Nutr. 2012;96(2):309–24. 10.3945/ajcn.111.031500
- Littrell M, Sow GD, Ngom A, Ba M, Mboup BM, Dieye Y, et al. Case investigation and reactive case detection for malaria elimination in northern Senegal. Malar J. 2013;12(1):331.
- Allen L, De Benoist B, Dary O, Hurrell R. Guidelines on food fortification with micronutrients [Internet]. Geneva; 2006.
- Theo C, Wreesmann J. Reasons for raising the maximum acceptable daily intake of EDTA and the benefits for iron fortification of foods for children 6–24 months of age. Matern Child Nutr. 2014;(10):481–495.
- Sazawal S, Habib AA, Dhingra U, Dutta A, Dhingra P, Sarkar A, et al. Impact of micronutrient fortification of yoghurt on micronutrient status markers and growth—a randomized double blind controlled trial among school children in Bangladesh. BMC Public Health [Internet]. 2013;13:1 Available from:
- Bernard T, Hidrobo M, Le Port A, Rawat R. Nutrition incentives in dairy contract farming in Northern Senegal [Internet]. 2015. file:///D:/Users/ALePort/Documents/bibliographie/Biblio value chain/papier value chain/NEUDC2015-253.pdf
- Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, Onis M De, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;(382):427–51.
Source: PubMed