In Bangladesh, BRAC uses Sasthya Shebikas (SS) as frontline health workers, for the promotion of appropriate infant and young child feeding, and to sell micronutrient powder (MNP) at low cost for children under-5. We aimed to understand the association between home contact by SSs and coverage of MNP among the targeted children in Bangladesh.
We conducted two coverage surveys at a 12 month interval: baseline and endline, using a modified stepped-wedge design in 10 program districts of BRAC. We collected data from the caregivers of children aged 6-59 months by using a structured questionnaire and identified households by a two-stage sampling strategy. For analysis, we used R (v 3.0.2) and performed bivariate and multiple logistic regression analysis.
We interviewed 1927 caregivers during baseline and 1924 caregivers during endline. The children who ever used MNP significantly increased from 23.5% in baseline to 36.8% in endline (p<0.001). The use of MNP in the households visited by SSs within one year increased significantly by 21 percentage points (p<0.001) while it only increased by 6 percentage points in the households that were not visited by the SSs in the same period. Other barriers to coverage were perceived lack of need for MNP among caregivers, older aged caregivers were less likely to give MNP and running out of MNP at the household level.
Our analysis suggests that home visits of SS are important to improve MNP coverage. We recommend taking initiatives to increase home contact by SSs and to reduce barriers to the MNP coverage.