The Integrated Strategy for Attention in Nutrition (EsIAN) Reduces the Prevalence of Anemia in Children 6 to 59 Months in the Context of a Conditional Cash-transfer Program in Mexico

Abstract

Objectives: EsIAN is designed to improve nutritional outcomes through a strong behavior change campaign and free distribution of nutritional products (micronutrient powders, MNP and/or a fortified complementary food, FCF) for children 6 m to 5 y of age living in poverty.  Both products were distributed in rural areas and MNP only in urban. We assessed changes in the prevalence of anemia in children, in a pre-post effectiveness trial. Methods: EsIAN was implemented in 2008 in 91 health care centers in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two cross-sectional samples of children aged 6 to 59 months (Rural:  2008 n=802, 2012 n=356; 2008 n=569, Urban:  2012 n=546) were analyzed adjusting standard errors by health care center clusters. Results: In rural areas, the concentration of hemoglobin increased from 12.0±0.1 (mean±SE) in 2008 to 12.7±0.1 g/dL in 2012 (P˂0.001). The prevalence of anemia dropped significantly both in urban (23.1±2.5% in 2008; 16.1±2.0% in 2012; P<0.05) and rural areas (23.5±2.0% in 2008; 7.0±1.3% in 2012; P˂0.001). The drop was largest among children aged 6 to 23 months in rural areas (28.3±4.5% percentage points reduction). Conclusions: We document here a dramatic reduction in the prevalence of anemia in communities where EsIAN was implemented.  Although this pre-post design does not allow for direct causal attribution, impact pathway review suggests that these changes are likely to be due to the EsIAN.