COMPARING THE EFFECTIVENESS AND COST-EFFECTIVENESS OF FACILITY- VERSUS COMMUNITY-BASED DISTRIBUTION OF MICRONUTRIENT POWDERS IN RURAL UGANDA

Background and objectives: Micronutrient powders (MNP) are one of the few available nutrition interventions shown to reduce anemia and iron deficiency. While efficacy is well established, regular and sustained use of MNP in program settings has faced challenges. To better understand MNP delivery channels, we compared the effectiveness and cost-effectiveness of facility versus community-based distribution. Methods: We conducted the randomized intervention study in Namutumba, Uganda. The six sub-counties in Namutumba were randomly allocated to either a health facility (HF) or voluntary health team members [(VHT) (i.e. community health worker)] distribution arm. Individual packets containing 30 MNP sachets, a two-month supply, were available to caregivers from February to November 2016. Cost data were continuously collected, and included total direct and indirect costs to NGO implementers, delivery channel providers, and beneficiaries. A cross-sectional survey was conducted at the end of the intervention to obtain data on the following program outcomes: coverage (consumed MNP in the previous 24 hours), intake adherence (received more than 2 packets of MNP), and appropriate use (no more than one sachet per day, MNP consumed with food, and minimum of 3 sachets consumed in the previous week). Unweighted and unadjusted data were analyzed based on intention to treat using chi-square tests. Results: Data for analysis were available on 1060 children 8-23 months. Nearly all caregivers had heard of MNP (100% VHT versus 98% HF, p