High Coverage and Low Utilization of the Double Fortified Salt Program in Uttar Pradesh, India: Implications for...

Area of Science:

• Public Health
• Nutrition Science
• Micronutrient Interventions

Background:

• Double fortified salt (DFS) is an effective strategy for iron deficiency anemia, yet limited evidence exists on its real-world program implementation and effectiveness.
• Previous evaluations of DFS programs often lack crucial details on program execution, hindering programmatic decision-making and scalability.

Purpose of the Study:

• To assess the coverage and adherence of a DFS program delivered via India's Public Distribution System (PDS) in Uttar Pradesh.
• To identify key factors influencing DFS adherence among beneficiaries, including household wealth and food security.

Main Methods:

• A survey of 1202 households across 5 districts after 8 months of DFS program implementation.
• Utilized principal component analysis for wealth quintile categorization and path analysis to examine drivers of DFS adherence, with PDS utilization as a mediator.

Main Results:

• The DFS program achieved high awareness (83%) and purchase rates (74%), but exclusive adherence was low (23%).
• Lower household wealth quintiles and food insecurity were associated with higher DFS adherence, mediated by regular PDS utilization.
• Awareness of DFS benefits was low, and perceived product quality was poor, with lower adherence in urban areas.

Conclusions:

• Significant heterogeneity exists in DFS program implementation, characterized by high coverage but suboptimal adherence.
• Process evaluation findings offer generalizable insights for improving DFS program impact, emphasizing the need to enhance awareness, product quality, and address sensory concerns.