An effective delivery strategy coupled with relevant social and behaviour change communication (SBCC) have been identified as central to the implementation of micronutrient powders (MNP) interventions, but there has been limited documentation of what works. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” three working groups were formed to summarize experiences and lessons across countries regarding MNP interventions for young children. This paper focuses on programmatic experiences related to MNP delivery (models, platforms, and channels), SBCC, and training. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that most countries distributed MNP free of charge via the health sector, although distribution through other platforms and using subsidized fee for product or mixed payment models have also been used. Community‐based distribution channels have generally shown higher coverage and when part of an infant and young child feeding approach, may provide additional benefit given their complementarity. SBCC for MNP has worked best when focused on meeting the MNP behavioural objectives (appropriate use, intake adherence, and related infant and young child feeding behaviours). Programmers have learned that reincorporating SBCC and training throughout the intervention life cycle has allowed for much needed adaptations. Diverse experiences delivering MNP exist, and although no one‐size‐fits‐all approach emerged, well‐established delivery platforms, community involvement, and SBCC‐centred designs tended to have more success. Much still needs to be learned on MNP delivery, and we propose a set of implementation research questions that require further investigation.

Iron deficiency anaemia is estimated to be the leading cause of years lived with disability among children. Young children's diets are often inadequate in iron and other micronutrients, and provision of essential vitamin and minerals has long been recommended. With the limited programmatic success of iron drop/syrup interventions, interest in micronutrient powders (MNP) has increased. MNP are a mixture of vitamins and minerals, enclosed in single‐dose sachets, which are stirred into a child's portion of food immediately before consumption. MNP are an efficacious intervention for reducing iron deficiency anaemia and filling important nutrient gaps in children 6–23 months of age. As of 2014, 50 countries have implemented MNP programmes including 9 at a national level. This paper provides an overview of a 3‐paper series, based on findings from the “Micronutrient Powders Consultation: Lessons Learned for Operational Guidance” held by the USAID‐funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. The objectives of the Consultation were to identify and summarize the most recent MNP programme experiences and lessons learned for operationalizing MNP for young children and prioritize an implementation research agenda. The Consultation was composed of 3 working groups that used the following methods: deliberations among 49 MNP programme implementers and experts, a review of published and grey literature, questionnaires, and key informant interviews, described in this overview. The following articles summarize findings in 3 broad programme areas: planning, implementation, and continual programme improvement. The papers also outline priorities for implementation research to inform improved operationalization of MNP.

Eight in ten female readymade garment (RMG) workers in Bangladesh suffer from anemia, a condition which damages both health and productivity. This study evaluated the effectiveness of a workplace nutrition program on anemia reduction in female RMG workers of Bangladesh. A quasi-experimental mixed method study was conducted on 1310 non-pregnant female RMG workers from four factories. Two types of intervention packages (A and C) were tested against their respective controls (B and D) over a 10-month period. Among factories that already provided lunch to workers with regular behavior change counseling (BCC), one intervention (A) and one control (B) factory were selected, and among factories that did not provide lunches to their workers but provided regular BCC, one intervention (C) and one control (D) factory were selected: (A) Lunch meal intervention package: daily nutritionally-enhanced (with fortified rice) hot lunch, once weekly iron-folic acid (IFA) supplement and monthly enhanced (with nutrition module) behavior change counseling (BCC) versus (B) Lunch meal control package: regular lunch and BCC; and (C) Non-meal intervention package: twice-weekly IFA and enhanced BCC versus (D) Non-meal control package: BCC alone. Body weight and capillary hemoglobin were measured. Changes in anemia prevalence were estimated by difference-in-difference (DID) method. Thematic analysis of qualitative in-depth interviews with RMG workers was performed and findings were triangulated. Anemia was reduced significantly in both lunch meal and non-meal intervention (A and C) group (DID: 32 and 12 percentage points, p: <0.001 and <0.05 respectively). The mean hemoglobin concentration also significantly increased by 1 gm/dL and 0.4 gm/dL in both A and C group (p: <0.001 respectively). Weight did not change in the intervention groups (A and C) but significantly increased by more than 1.5 kg in the comparison groups (B and D). The knowledge of different vitamin and mineral containing foods and their benefits was increased significantly among all participants. Workplace nutrition programs can reduce anemia in female RMG workers, with the greatest benefits observed when both nutritionally enhanced lunches and IFA supplements are provided.

Realistic planning for a nutrition intervention is a critical component of implementation, yet effective approaches have been poorly documented. Under the auspices of “The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,” 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powders (MNP) interventions for young children. This paper focuses on programmatic experiences in the planning stages of an MNP intervention, encompassing assessment, enabling environment and adaptation, as well as considerations for supply. Methods included a review of published and grey literature, key informant interviews, and deliberations throughout the consultation process. We found that assessments helped justify adopting an MNP intervention, but these assessments were often limited by their narrow scope and inadequate data. Establishing coordinating bodies and integrating MNP into existing policies and programmes have helped foster an enabling environment and support programme stability. Formative research and pilots have been used to adapt MNP interventions to specific contexts, but they have been insufficient to inform scale‐up. In terms of supply, most countries have opted to procure MNP through international suppliers, but this still requires understanding and navigating the local regulatory environment at the earliest stages of an intervention. Overall, these findings indicate that although some key planning and supply activities are generally undertaken, improvements are needed to plan for effective scale‐up. Much still needs to be learned on MNP planning, and we propose a set of research questions that require further investigation.

One in three people globally suffers from at least one form of malnutrition, leading to poor health outcomes and low productivity in the workplace. The workplace offers an important, relatively unexploited opportunity to address malnutrition in all its forms. This narrative literature review aims to understand the impact of workforce nutrition programmes on nutrition, health, and business outcomes, based on high-strength-of-evidence studies. We used PubMed as our primary research database, complemented by Google Scholar, to identify systematic reviews, meta-analyses, and randomised controlled trials published between January 2010 and October 2021. In total, 26 records were included. We found that comprehensive workforce nutrition programmes, including a variety of intervention areas, and/or programmes targeting high-risk categories of workers (overweight/obese or (pre-)diabetic) were more likely to be effective on nutrition, health, and business outcomes. Within comprehensive and targeted programmes, individualised counselling and worksite environmental modifications were often mentioned as the most effective components. However, a high degree of heterogeneity in outcome measures and programme designs made it difficult to draw strong conclusions on the impact of workforce nutrition interventions. Limited evidence was found on business outcomes, longer-term effects of interventions, and programme implementation in LMICs. Therefore, further research is needed to address these evidence gaps.

Many workers in global supply chains remain nutritionally vulnerable despite the income they earn. The Seeds of Prosperity (SOP) program was implemented in Tamil Nadu and Assam, India, for tea supply chain workers (estate workers, small holder farmers, and farm workers). The aim was to enhance demand for diverse and nutritious foods and improve practices related to handwashing. The program used a behavior change communication approach wherein participants received weekly 1-hour group sessions with messaging on dietary diversity for 5 weeks and handwashing for 4 weeks. An impact evaluation was conducted to estimate changes in reported dietary and hygiene knowledge and behaviors among women. The study used a longitudinal quasi-experimental design in a subsample of program participants at baseline and post-intervention among both intervention and comparison. There was a small but significant increase in mean dietary diversity (DD) for all 4 worker groups (ranging from DD score changes of 0.3 to 0.7; P < .05) and in the proportion of women meeting the minimum dietary diversity in 2 of the 4 groups. Similarly, a significant increase in the mean number of handwashing moments was observed in 2 of the worker groups. An increase in home garden use was observed in 1 of the 4 worker groups. While the SOP program resulted in improvements in dietary diversity, most tea farming women still do not achieve minimum dietary diversity. Nutritious food access may be an important constraint to further improvement.