DELIVERY OF MICROENCAPSULATED IRON SPRINKLES IN RURAL POOR THROUGH FEMALE HEALTH WORKERS: LESSONS LEARNED AT BRAC IN BANGLADESH

S.M. Ziauddin Hyder, Farhana Haseen, Mizanur Rahman, Stanley H Zlotkin

Background: Programs to control iron deficiency in children have been ineffective largely because of poor acceptance of available intervention (iron drops) and low coverage. Micronutrient Sprinkles are single-serve sachets of tasteless dry powder that are used to fortify homemade weaning foods that have been found to be efficacious and safe. Integration of this intervention within an integrated rural development program that uses indigenous female health workers can potentially increase the intervention acceptance and ability to reach the poorest and thus offer a great option to improve program effectiveness.

Objectives: To determine the acceptability of micronutrient Sprinkles for children aged 12-24 months among mothers in a relatively poor rural community in Bangladesh.

Methods: A study was conducted from September-November, 2004 among 140 children and their respective mothers in 13 villages of Kaligonj sub-district, which was integrated within a rural development program implemented by BRAC (the largest national NGO) in Bangladesh. A cadre of female health workers supplied Sprinkles to mothers for two months along with an information and motivation package. Mothers were visited weekly and requested to use one sachet of Sprinkles daily. At the end of this intervention, coverage and acceptability was determined using the program registers, by interviewing mothers and also by conducting focus group discussions (FGDs). Four FGDs were conducted, each attended by 7-8 mothers.

Results: Inclusion of the Sprinkles intervention within BARC's rural development program was found to be feasible. This additional activity was highly preferred by the female health workers. Sixty percent of mothers 'extremely liked', 30% 'liked', 10% 'somewhat liked' the intervention, measured on a four point scale. Major health benefits as perceived by the mothers included: general improvement of child's health (100%), increased children's appetite (29%) and playfulness (28%) and faster intellectual development (28%). Mixing of Sprinkles with weaning food did not change normal food smell in 91%, color 98% and taste 99%. Major reasons to like this intervention included 'easy to use', 'encouraged regular weaning', 'encouraged children to eat more', and 'mothers' frequent interactions with health worker'. Sprinkles were commonly known as Pusti gura (nutrition powder) which was thought to increase 'the strength of weaning foods'.

Conclusion: Micronutrient Sprinkles were found to be highly acceptable among this group of mothers in Bangladesh. This intervention can be delivered to the hard-to-reach rural population and be sustained through its integration with an on-going development program like BRAC using their indigenous health workers.