Sustainability of market‐based community distribution of S prinkles in western K enya

To evaluate the sustainability of market‐based community distribution of micronutrient powders ( S prinkles ® , Hexagon Nutrition, Mumbai, India.) among pre‐school children in K enya, we conducted in A ugust 2010 a follow‐up survey, 18 months after study‐related marketing and household monitoring ended. We surveyed 849 children aged 6–35 months randomly selected from 60 study villages. Nutritional biomarkers were measured by fingerstick; demographic characteristics, S prinkles purchases and use were assessed through household questionnaires. We compared Sprinkles use, marketing efforts and biomarker levels with the data from surveys conducted in M arch 2007, M arch 2008 and M arch 2009. We used logistic regression to evaluate associations between marketing activities and Sprinkles use in the 2010 survey. At the 2010 follow‐up, 21.9% of children used S prinkles in the previous 7 days, compared with 64.9% in 2008 ( P  < 0.001). Average intake was 3.2 sachets week −1 in 2008, 1.6 sachets week −1 in 2009 and 1.1 sachets week −1 in 2010 ( P  < 0.001). Factors associated with recent Sprinkles use in 2010 included young age [6–23 months vs. 24–35 months, adjusted odds ratio (a OR ) = 1.5, P  = 0.02], lowest 2 quintiles of socio‐economic status (a OR  = 1.7, P  = 0.004), household attendance at trainings or launches (a OR  = 2.8, P  < 0.001) and ever receiving promotional items including free S prinkles, calendars, cups and t‐shirts (a OR  = 1.7, P  = 0.04). In 2010, there was increased prevalence of anaemia and malaria ( P  < 0.001), but not iron deficiency ( P  = 0.44), compared with that in 2008. S prinkles use in 2010 was associated with decreased iron deficiency ( P  = 0.03). S prinkles coverage reduced after stopping household monitoring and reducing marketing activities. Continued promotion and monitoring of S prinkles usage may be important components to sustain the programme.