ArticleCurrent developments in nutrition2020
High Coverage and Low Utilization of the Double Fortified Salt Program in Uttar Pradesh, India: Implications for Program Implementation and Evaluation.
Article in Current developments in nutrition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Fortification of salt with iron and iodine versus fortification of salt with iodine alone for improving iron and iodine status.The Cochrane database of systematic reviews · 2022Pooled it
- A Randomized Crossover Trial of Acceptability of Quadruple-Fortified Salt in Women and their Households in Southern India.The Journal of nutrition · 2025Trial
- Quantifying the Potential Impact of Food Fortification on Iron Intake, Hemoglobin Concentration and Anemia Prevalence Among Women of Reproductive Age in India.Maternal & child nutrition · 2026Article
- Monitoring Biofortification Program Performance and Potential for Impact: Indicators, Methods, and Learnings from the Commercialization of Biofortified Crops Program in Six Countries across Africa and Asia.Current developments in nutrition · 2024Article
- A proposed method for defining the required fortification level of micronutrients in foods: An example using iron.European journal of clinical nutrition · 2023Review
- The Role of Multiply-Fortified Table Salt and Bouillon in Food Systems Transformation.Nutrients · 2022Article
- Making programmes worth their salt: Assessing the context, fidelity and outcomes of implementation of the double fortified salt programme in Uttar Pradesh, India.Maternal & child nutrition · 2022Article
- The Impact of Double-Fortified Salt Delivered Through the Public Distribution System on Iodine Status in Women of Reproductive Age in Rural India.Current developments in nutrition · 2021Article
- Key Considerations for Policymakers-Iodized Salt as a Vehicle for Iron Fortification: Current Evidence, Challenges, and Knowledge Gaps.The Journal of nutrition · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDouble fortified salt (DFS) is efficacious in addressing iron deficiency, but evidence of its effectiveness is limited. The few published evaluations do not include details on program implementation, limiting their utility for programmatic decisions.
objectivesWe sought to characterize the coverage of a DFS program implemented through the Public Distribution System (PDS) in Uttar Pradesh, India, and understand the drivers of DFS adherence.
methodsAfter 8 mo of implementation, we surveyed 1202 households in 5 districts and collected data on sociodemographic characteristics, asset ownership, food security, and regular PDS utilization. We defined DFS program coverage as the proportion of PDS beneficiaries who had heard of and purchased DFS, and we defined DFS adherence as DFS use reported by households. We used principal component analysis to create an asset-based index of relative wealth, and we categorized households into higher/lower relative wealth quintiles. We conducted path analyses to examine the drivers of DFS adherence, particularly the mediated influence of household wealth on DFS adherence. The evaluation is registered with 3ie's Registry for International Development Impact Evaluations (RIDIE-STUDY-ID-58f6eeb45c050).
resultsThe DFS program had good coverage: 83% of respondents had heard of DFS and 74% had purchased it at least once. However, only 23% exclusively used DFS. Respondents had low awareness about DFS benefits and considered DFS quality as poor. Being in a lower household wealth quintile and being food insecure were significant drivers of DFS adherence, and regular PDS utilization acted as a mediator. Adherence was lower in urban areas.
conclusionsWe observed significant heterogeneity in DFS implementation as reflected by high coverage and low adherence. Findings from this process evaluation informed the design of an adaptive impact evaluation and provided generalizable insights for ensuring that the potential for impact is realized. Efforts are needed to increase awareness, improve product quality, as well as mitigate against the sensory challenges identified.
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