The Effectiveness of Nutritional Interventions on Maternal and Childhood Anaemia in Sindh, Pakistan.

Maternal anaemia declined substantially more in intervention areas than control areas over the study period.

• Maternal anaemia declined from 80.4% to 62.6% in intervention areas compared with a smaller reduction from 80.0% to 72.9% in control areas.
• The difference-in-difference (DID) estimate showed a 10.7-percentage-point greater decline in maternal anaemia in intervention areas (p ≤ 0.001).
• The study used a quasi-experimental design with kernel propensity score matching applied to difference-in-difference analysis.
• A total of 2821 and 2410 pregnant and lactating women participated in the baseline and endline surveys, respectively.

Both pregnant and lactating women separately showed significant reductions in anaemia attributable to the intervention.

• Pregnant women showed a DID reduction of 16.7 percentage points (p ≤ 0.001).
• Lactating women showed a DID reduction of 9.4 percentage points (p = 0.005).
• The intervention included 5 kg (165 g/day) of wheat soya blend (WSB) per month throughout pregnancy and the first six months of exclusive breastfeeding.
• Both groups also had access to routine iron-folic acid supplementation during pregnancy in both intervention and control areas.

The largest maternal anaemia reductions occurred among women in higher-wealth quintiles.

• Women in higher-wealth quintiles experienced reductions of up to 22.6 percentage points (p ≤ 0.001).
• This subgroup analysis was conducted as part of the difference-in-difference analysis with kernel propensity score matching.
• The study areas were matched for demographic and economic characteristics at baseline.

The nutritional intervention showed no overall significant effect on childhood anaemia.

• The overall DID estimate for childhood anaemia was -0.7 percentage points (p = 0.73), which was not statistically significant.
• A total of 3397 and 3277 children aged 6-59 months participated in the baseline and endline surveys, respectively.
• Children aged 6-23 months received lipid-based nutrient supplements (LNS), and those aged 24-59 months received micronutrient powder.
• Anaemia reduction in children was assessed as a secondary outcome of a stunting prevention programme.

Significant improvements in childhood anaemia were observed in specific subgroups despite the lack of overall effect.

• Male children showed a significant DID reduction of 10.3 percentage points (p = 0.001).
• Children in higher-wealth quintiles showed a significant DID reduction of 15.0 percentage points (p = 0.002).
• No significant overall effect was found across the full 6-59 month age group (DID = -0.7 pp, p = 0.73).

The baseline prevalence of anaemia in Pakistan is high among both women of reproductive age and young children.

• 41.7% of women of reproductive age in Pakistan are anaemic.
• 53.7% of children aged 6-59 months in Pakistan are anaemic.
• At baseline, both intervention and control areas had maternal anaemia prevalence of approximately 80%, indicating a high-burden setting.

The study employed a quasi-experimental design with difference-in-difference analysis and kernel propensity score matching to assess programme impact.

• Study areas were matched for demographic and economic characteristics.
• Both intervention and control areas had routine public-sector health and nutrition programmes, including iron-folic acid supplementation during pregnancy.
• The intervention was delivered through Lady Health Workers (LHWs) and included behaviour change communication alongside nutritional supplementation.
• Anaemia was assessed as a secondary outcome of a stunting prevention programme.