Intervention to fight anemia and improve well-being in a very low income setting

Iron deficiency anemia (IDA) has been linked to low productivity in adults, slowing of cognitive and physical growth among children and, in the elderly, increased risk of cognitive impairment and physical disability, as well as decreased muscle strength. While iron deficiency anemia has been recognized to be a serious public health problem in developing countries for several years, something that both limits the working population and increases risks for cognitive impairment and health shocks in the elderly, not much progress has yet been made against it. Distributing iron supplements appears to be an impractical policy in resource-poor settings where the public health systems do not have the capacity to maintain a large-scale distribution system. Iron supplementation of foods is therefore an attractive alternative: it requires no additional effort on the part of the consumer, and can be done relatively cheaply in centralized locations.

This study is a cluster-randomized trial in Bhojpur District (Bihar) of Double (iron and iodine) Fortified Salt (DFS), a fortified food designed to prevent anemia. We randomly assign 200 villages where DFS is made available for purchase through private shops and PDS stores, and randomly assign 200 villages to no intervention. We also conduct an information campaign in each treatment village to tell households about the new product.

We measure health impact using all individuals in 15 randomly selected households within each village. They complete a baseline survey as well as an endline after approximately one year. The main outcomes of interest are haemoglobin level, anemia, weakness, absence from work/school and cognitive health.