Archis Banerjee

Measuring food fortification coverage in household surveys: Formative research findings from Bangladesh and Ethiopia

Background Large-scale food fortification (LSFF) is a cost-effective approach used in most countries to address widespread micronutrient deficiencies. Understanding who consumes fortified foods is challenging as these foods are often undetectable by design. The objective of this work was to refine survey items used to measure LSFF coverage for their potential use in routine multitopic household surveys. Methods In Bangladesh and Ethiopia, we interviewed shop vendors (n=108), program officers (n=28), and women beneficiaries of safety net programs (n=67). Shop observations assessed availability, type, brand, and fortification labeling for food vehicles (oil, wheat flour, salt, and rice). Key informant interviews were used to understand practices related to food acquisition/use and fortification knowledge. Cognitive interviewing techniques were used to refine questions from the Fortification Assessment Coverage Toolkit (FACT), with follow-up prompts to identify comprehension, retrieval, judgment, and response errors. Results Market observations revealed many types and brands of food vehicles, especially of rice in Bangladesh (35 types, 220 brands). Nearly all oil and salt, but not wheat flour in both countries or rice in Bangladesh were labeled as fortified. Program officers and women had limited knowledge about fortified foods. The concept of brand was not well understood, and women often could not remember the brand they last purchased. Modifications to the FACT survey items reduced cognitive errors. A set of four questions can capture household coverage of food vehicle and fortifiable food vehicle use. Conclusions Correct phrasing of key concepts as understood by respondents is essential to producing reliable estimates of LSFF coverage. In the absence of cheap, field-friendly technologies to test food samples, and given limited identifiable features of fortified foods, estimating coverage of fortification programs in household surveys remains challenging but worthy of further investigation.

Gender roles in South Asian food systems

Methodological considerations and cost to measure coverage of multisectoral nutrition interventions: Protocol for the One Nutrition Coverage Survey in Bangladesh

Introduction Despite global commitments to eliminate malnutrition, over half the world’s population remains affected. Multisectoral nutrition interventions targeting both proximate and distal causes of malnutrition are essential across the lifespan. Yet, current data collection lacks comprehensive nutrition intervention coverage measures, risking inaccuracies in tracking progress. The One Nutrition Coverage Survey (ONCS) aims to test new and refined coverage measurement methods, assess coverage equity and guide integration into large-scale household surveys. Methods and analysis The ONCS will be a cross-sectional, population-representative household survey conducted in four districts of Bangladesh (Rangpur, Sylhet, Dhaka and Khulna), selected for their geographic spread and urban–rural balance. A stratified multistage sampling approach will be used to select enumeration areas, and a total of approximately 3280 households randomly selected within each EA will be included in the survey. The survey will interview women of reproductive age (15–49 years), caregivers of children (0–9 years), adolescents (10–19 years) and pregnant women, collecting data on multisectoral nutrition interventions relevant to these groups. It will use both existing and new measures, while also capturing monetary and non-monetary costs for survey design to implementation. Data will be analysed to assess coverage, co-coverage and equity by sociodemographic characteristics, as well as the feasibility, accuracy and costs of the survey approach. Ethics and dissemination The study protocol and instruments were reviewed and approved by the International Centre for Diarrhoeal Disease Research, Bangladesh’s (icddr,b) Ethical Review Board in Bangladesh and the International Food Policy Research Institute’s Institutional Review Board in Washington, DC, USA. Adults provided signed informed consent and adolescents their assent. Findings will be shared through peer-reviewed publications, conferences and presentations in Bangladesh with key stakeholders. This study will yield new tools, methods and evidence for measuring multisectoral nutrition intervention coverage, applicable to other low-income and middle-income countries. Learnings from ONCS will enhance data collection aligned with national strategies, helping governments improve coverage assessments, inform decisions and strengthen programme monitoring.