title: 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: BACKGROUND
  Innovative 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Anemia 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)).
  
  
  CONCLUSIONS
  The 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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02079961.
authors.affiliation: Poverty Health and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal.
authors.forename: Agnes
authors.initials: A
authors.lastname: Le Port
authors.affiliation: Markets, Trade and Institutions, International Food Policy Research Institute, Dakar, Senegal.|GREThA, UMR CNRS 5113, University of Bordeaux, Bordeaux, France.
authors.forename: Tanguy
authors.initials: T
authors.lastname: Bernard
authors.affiliation: Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington DC, United States of America.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hidrobo
authors.affiliation: Poverty Health and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal.
authors.forename: Ousmane
authors.initials: O
authors.lastname: Birba
authors.affiliation: Poverty Health and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rawat
authors.affiliation: Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington DC, United States of America.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Ruel
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000517:prevention & control*; D000818:Animals; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D016000:Cluster Analysis; D005260:Female; D005527:Food, Fortified / Q000032:analysis*; D015438:Health Behavior; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008892:Milk / Q000737:chemistry; D009752:Nutritional Status; D012044:Regression Analysis; D012424:Rural Population; D018401:Sample Size; D012621:Seasons; D012675:Senegal; D015014:Yogurt
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D007501:Iron