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

Abstract

BackgroundInnovative 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.MethodsA 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 findingsAnemia 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)).ConclusionThe 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 registrationClinicalTrials.gov NCT02079961

Value Chains and Diet Quality: A Review of Impact Pathways and Intervention Strategies

“…Hattersley [53] used a nutrition-oriented value chain approach to study changes in the processed deciduous fruit market in Australia. Around half (i.e., 16) of the studies concerned countries in Sub-Saharan Africa, including Burkina Faso, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Liberia, Senegal, South Africa, and Uganda [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69]. The next most frequently studied region was South Asia (9 studies), including Afghanistan, Bangladesh, and India [13,56,57,[70][71][72][73][74][75].…”

“…Bio-fortified iron beans [20] Mandatory industrial fortification of a food commodity National Wheat Flour Fortification Programme in Pakistan [82] Voluntary industrial fortification of a processed food product Iron-fortified glucose biscuits in India [61]. Iron-fortified yogurt in Senegal [64] Increase the availability of nutritious whole food Household and community production of fruits, vegetables and livestock products Home gardening programs in Bangladesh [57]. Adoption of improved dairy cow breeds in Uganda [62] Changes in distribution and retailing that extend the number of hours and days when healthy whole foods can be purchased Distribution systems that include permanent retail outlets, petrol stations, convenience stores and schools [53] Changes in the production and distribution systems that extend the seasonal availability of healthy whole foods Staggered planting to extend harvest seasons [63].…”

“…Ansari et al [82] discuss the national wheat flour fortification programme in Pakistan, noting the potential for such programs to bypass vulnerable populations who may access food via informal value chains. There are also various examples of the voluntary fortification of processed food products, including breakfast cereals [61], yogurt [64], and sweet biscuits [72].…”

“…For example, in India, awareness of the nutritional benefits of small millets was found to be rather low [13]. In Northern Senegal, major dietary sources of iron were poorly understood by mothers [64]. In Mozambique, value chain projects designed to increase consumption of orange-flesh sweet potato have included mass media, local drama, and direct contact with consumers.…”

“…In Mozambique, value chain projects designed to increase consumption of orange-flesh sweet potato have included mass media, local drama, and direct contact with consumers. In Northern Senegal, a communication campaign focussing on anaemia prevention was included in a project that developed an iron-fortified yogurt [64]. In Bangladesh, efforts to develop dairy value chains were accompanied by a communication program designed to increase awareness of the benefits of milk consumption by women and children who were found to be consuming less than the national recommended levels [75].…”